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Article Dans Une Revue Nature Medicine Année : 2024

Multimodal assessment improves neuroprognosis performance in clinically unresponsive critical-care patients with brain injury

F Raimondo
L Belloli
D Manasova
J D Sitt

Résumé

Accurately predicting functional outcomes for unresponsive patients with acute brain injury is a medical, scientific and ethical challenge. This prospective study assesses how a multimodal approach combining various numbers of behavioral, neuroimaging and electrophysiological markers affects the performance of outcome predictions. We analyzed data from 349 patients admitted to a tertiary neurointensive care unit between 2009 and 2021, categorizing prognoses as good, uncertain or poor, and compared these predictions with observed outcomes using the Glasgow Outcome Scale–Extended (GOS-E, levels ranging from 1 to 8, with higher levels indicating better outcomes). After excluding cases with life-sustaining therapy withdrawal to mitigate the self-fulfilling prophecy bias, our findings reveal that a good prognosis, compared with a poor or uncertain one, is associated with better one-year functional outcomes (common odds ratio (95% CI) for higher GOS-E: OR = 14.57 (5.70–40.32), P < 0.001; and 2.9 (1.56–5.45), P < 0.001, respectively). Moreover, increasing the number of assessment modalities decreased uncertainty (OR = 0.35 (0.21–0.59), P < 0.001) and improved prognostic accuracy (OR = 2.72 (1.18–6.47), P = 0.011). Our results underscore the value of multimodal assessment in refining neuroprognostic precision, thereby offering a robust foundation for clinical decision-making processes for acutely brain-injured patients.
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Dates et versions

hal-04598223 , version 1 (03-06-2024)

Identifiants

Citer

Benjamin Rohaut, C Calligaris, B Hermann, P Perez, F Faugeras, et al.. Multimodal assessment improves neuroprognosis performance in clinically unresponsive critical-care patients with brain injury. Nature Medicine, 2024, Online ahead of print. ⟨10.1038/s41591-024-03019-1⟩. ⟨hal-04598223⟩
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