Identifying Meaningful Outcome Metrics in Severe Brain Injury

Neuroprognostication for patients who have experienced a brain injury, such as after cardiac arrest or trauma, is critical. Predictions of an “unfavorable” recovery frequently result in withdrawal of life-sustaining treatment (LST), and therefore death. Most studies equate any degree of functional dependence as “unfavorable”, despite data that many functionally dependent survivors of coma report favorable quality of life, and that acceptability of dependence may differ across racial groups. The potential consequences of this oversimplified, and perhaps biased, interpretation of acceptable outcomes are profound, as they may result in inappropriate continuation or withdrawal of LST and thus avoidable morbidity and mortality. In this project, we will use surveys and semi-structured interviews to investigate the attitudes and preferences of patients and their families around acceptable outcomes after brain injury. We will further explore how these preferences may vary with respect to patient race. These results will inform future prognostication research, clinical practice, and health policy. 

Leonard Davis Institute of Health Economics