Articles: injury.
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Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis. ⋯ The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.
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Curr Opin Crit Care · Jan 2025
Natural history of recovery and long-term outcome in critically ill patients with brain injury.
To increase knowledge of the natural history of recovery and long-term outcome following severe traumatic brain injury (sTBI). ⋯ Evidence from large multicenter studies with well characterized samples focusing on recovery trajectories beyond 1 year postinjury challenge conventional beliefs about outcome after sTBI. Signs of consciousness frequently emerge following discharge from the ICU setting and prediction of death and dependency within the first few weeks after injury is unreliable. Clinician knowledge of the frequency and time course to recovery of key behavioral milestones is central to evidence-based prognostic counseling.
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Delirium is an acute state of confusion associated with adverse postoperative outcomes. Delirium is diagnosed clinically using screening tools; most cases go undetected. Identifying a delirium biomarker would allow for accurate diagnosis, application of therapies, and insight into causal pathways. To agnostically discover novel biomarkers of delirium, we conducted a case-control sub-study using the VISION-Cardiac Surgery biobank. Our objective was to identify candidate biomarkers to investigate in future studies. ⋯ We identified 26 biomarkers significantly associated with delirium; all are novel except for IL-8. We did not identify an association between delirium and recognized neuro-inflammatory proteins and markers of brain injury, which supports using biomarkers to differentiate between delirium and other neurological conditions. While exploratory, our findings support using biomarkers to diagnose postoperative delirium and validate using agnostic screens to identify potential delirium biomarkers.
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Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible. ⋯ The discussion explores how on these three levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e. not a neutral or desirable state of being), while, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also shows how patients and healthcare providers often orient to the stigma around chronic pain.