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Jama neurology coma prognostication
Jama neurology coma prognostication. Dr Sheth reported receiving grants Patients were identified from the University Medicine Rostock (2015-2021), University Hospital Göttingen (2010-2018), University Hospital Frankfurt (2014-2020), University Hospital Heidelberg (2015-2021), and University Hospital Jena (2008-2017). Mar 4, 2024 · The loss of consciousness, factors associated with recovery, and return to functional independence in a 31-year sample of patients with moderate or severe brain trauma is quantified to inform acute and rehabilitation treatment decisions and suggests caution is warranted in consideration of withdrawing or withholding care in patients with TBI and DOC. Withdrawal of life-sustaining therapy (WLST) is often the proximate cause of death. Findings In this cohort study including 1899 individuals, serum neurofilament light chain elevation, as a sign of accelerated neuroaxonal injury, was detected approximately 1 year preceding disability worsening events associated with relapses and 1 to 2 years Jun 5, 2018 · Hypoxic–ischaemic brain injury (HIBI) is the main cause of death in patients who are comatose after resuscitation from cardiac arrest. Trauma to the head causing no loss of consciousness and no evidence of focal brain injury may be inconsequential, even if there is evidence of Jul 23, 2020 · Key Points. Google Scholar President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research. Coma after successful emergency resuscitation from circulatory arrest, as a result of anoxic-ischemic brain damage, presents challenges for neurological management and prognostication. Question When does neuroaxonal pathology occur in people with multiple sclerosis (MS) who experience disability worsening?. JAMA Neurology 81(4): 405-415, 2024. Patients may be too unstable to leave the intensive care unit for neuroimaging; thus, repeated This paper suggests that the majority of the patients (78/116) with cerebral venous sinus thrombosis (CVST) presented incidences of thrombosis with thrombocytopenia syndrome (TTS) after SARS-CoV-2 vaccination of two vaccines under study, and patients presented CVST-TTS after the vaccination had high rates of coma and intracerebral hemorrhage and a high mortality rate. Question What is the optimal target temperature for targeted temperature management (TTM) in comatose patients after cardiac arrest?. Epub 2015 Jun 12. van Soest and Anne-Fleur van Rootselaar and Marjolein M Admiraal and Wouter V. Objective: To determine whether serum neurofilament light chain (NFL) levels can be used for prognostication of neurologic outcome after cardiac arrest. The most commonly used indicators of severe HIBI Sep 8, 2022 · The Vineland Adaptive Behavior Scales, third edition (VABS-3) provides age-corrected standard scores (mean [SD], 100 [15] points) for individuals from birth through age 90 years in 4 domains (communication, daily living, socialization, and motor skills) and an overall adaptive behavior composite score, with higher scores denoting better functioning. The timing of studies indicated above is summarized in the following table: During cooling cEEG Day 1* NSE. Mar 29, 2022 · A stepwise conceptual framework for reasoning through neuroprognostic determinations is offered — including an evaluation of neurological function, estimation of a recovery trajectory, definition of goals of care and consideration of patient values — culminating in a clinically actionable formula for weighing the risks and benefits of life-sustaining treatment. Feb 28, 2022 · This systematic review and meta-analysis evaluates the use of bloodborne brain injury biomarkers for neurologic prognostication in patients with hypoxic ischemic brain injury after cardiac arrest. OHCA indicates out-of-hospital cardiac arrest; ICU, intensive care unit; ROSC, return of spontaneous circulation. Optimized cutoffs of serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) z scores from receiver operating characteristic curve analysis, based on the Youden index, were used to dichotomize patient groups. Aug 10, 2005 · Each year, more than 80 000 patients with stroke die in US hospitals. Therapeutic Jan 30, 2019 · Key Points. Computer application of new multivariate techniques to … Jul 19, 2019 · A, Graph shows the −log 10 (P value) of significant cis–expression quantitative trait loci (eQTL) within ABCC8 (y-axis) and their location on the gene (x-axis). Question How do functional outcomes change from the acute to chronic phases of recovery after moderate to severe TBI (msTBI)?. Prognostication in comatose Jan 24, 2024 · JAMA Neurol. During the past decade, as Jan 1, 2013 · Approximately 450,000 Americans suffer cardiac arrest annually. Quality Standards Subcommittee of the American Academy of Neurology. 1 Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Apr 1, 2022 · We included studies that investigated neuron-specific enolase, S100 calcium-binding protein β, glial fibrillary acidic protein, neurofilament light, tau, or ubiquitin carboxyl hydrolase L1 in patients with cardiac arrest aged 18 years and older for neurologic prognostication. 27710, E1–E8 (2020). JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Key Points. doi: Images in Neurology; Implementation Science; patients with Glasgow Coma Scale (GCS) scores of 13 to 15 and (2 Affiliation 1 Division of Neurosciences Critical Care Departments of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and Radiology Johns Hopkins University School of Medicine Baltimore, MDDivision of the Cerebrovascular Diseases and Neurocritical Care Department of Neurology The Ohio State University Columbus, OH. Methods: The authors prospectively studied a consecutive series of post- Jul 11, 2019 · Significant improvements have been achieved in cardiac arrest resuscitation and postarrest resuscitation care, but mortality remains high. 2020;155(8):723 results from the TRACK-TBI study. EIC Andrew Josephson, MD, shares the Mar 26, 2019 · Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the post–cardiac arrest period. 1016/j. 2 and has generally been considered to have a serious prognostic implication. 033 Corpus ID: 233234122; SSEP amplitudes add information for prognostication in postanoxic coma. Previously, he was an Associate Professor of Neurology at Harvard Medical School and Associate Neuroscientist at MGH before joining the faculty at Yale. Mar 8, 1985 · Outcome from coma caused by cerebral hypoxia-ischemia (eg, cardiac arrest) was compared with serial neurological findings in 210 patients. Neurology (aged ≥17 years) with moderate or severe TBI (Glasgow Coma Scale [GCS] score JAMA Neurology (181) JAMA (137) JAMA Network Open (126) JAMA Pediatrics (94) JAMA Surgery (58) JAMA Ophthalmology (24) JAMA Psychiatry (21) JAMA Otolaryngology–Head We conducted a systematic review of all studies of status epilepticus (SE) with more than 30 patients published between January 1, 1990, and December 31, 2008, to determine the frequencies of the common underlying causes and the extent to which the underlying causes affect the prognosis of an Dr Testai reported grants from NIH during the conduct of the study. 1 Studies have shown that many patients with 1. Apr 10, 2021 · DOI: 10. Uncertainty of prognostication increases with more severe brain injury. T. 2019;76(9):1049-1059. Time-Dependent Probabilities of Observing a First EEG Event if Monitoring Were Continued, Stratified by Initial EEG Background Activity (1a – Suppressed Background; 1b – Burst Suppression; 1c – Continuous) and Whether or Not a Risk State Was Previously Observed Using Prognostic Event Definitions Jun 14, 2022 · This cohort study examines data from 3 single-center observational cohorts to test the capabilities of a commercially available plasma phosphorylated tau 217 immunoassay to identify Alzheimer disease pathophysiology. Aug 30, 2024 · JAMA Surg . Potters and Johannes H. a Reasons for not meeting inclusion (eligibility) criteria were as follows: not cardiac OHCA (n=75), age (n=53), Glasgow Coma Scale score >8 (n=49), and no stable ROSC (n=14). Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Early EEG contributes to multimodal outcome prediction of postanoxic coma. }, author={Thijs M. 3 The JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Jun 27, 2012 · A prognostication worksheet will be completed and left in the chart by the Postanoxic Coma Neurophysiology Consult (PCNC) Service service after completing the day 3 exam, or after cEEG and SSEP assessments are completed. Dr Frankel reported serving as a consultant for Spencer Fane LLP and Franke & Salloum, PLLC. — Alpha coma has been well described in postanoxic encephalopathy and brainstem stroke1. Sep 15, 2020 · This Special Communication summarizes consensus recommendations from the World Brain Death project, an international collaborative created to establish minimum standards for diagnosing brain death/death by neurologic criteria (BD/DNC) in children and adults across a broad range of settings and Mar 23, 2016 · Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Findings In this cohort study of 1154 patients with mild traumatic brain injury and 299 patients with orthopedic trauma serving as controls, 53% of participants with mild traumatic brain injury reported impairment 12 months postinjury vs 38% of Jun 1, 2021 · We retrospectively studied all adult patients with postanoxic coma after cardiac arrest in whom a median nerve SSEP was recorded for prognostication in the Amsterdam UMC, location AMC, from January 2010 to June 2018. Findings In a cohort study of 1319 patients, of whom 911 did not have severe cerebral edema or highly malignant electroencephalogram, TTM at 33 °C was associated with better survival than TTM at 36 °C for patients with the most severe post Supplement. Dr. This brain injury, commonly manifested as a comatose state, is a marker of poor outcome and a major basis for unfavorable neurological This pragmatic trial evaluates whether palliative care training for neurologists and remote access to a palliative care team can improve outcomes in patients with Parkinson disease and related disorders in community settings. Subgraphs show the SNV eQTL P values and chromosomal locations based on different tissue isolates from the Genotype Tissue Expression (GTEx) project (brain-specific eQTL, white area; non–brain eQTL, tan area). 03. Over the past 2 decades, there have been 9 phase III clinical trials testing interventions, such as hemostatic therapies, lowering blood pressure, and surgery for ICH. The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. M. SSEPDay 2* Day 3* Jun 30, 2023 · This cohort study analyzes the association of brain lesions seen on magnetic resonance imaging and concentrations of lactate and N-acetylaspartate seen on magnetic resonance spectroscopy with 1-year outcomes after pediatric cardiac arrest. 2021. Evidence suggests that level of consciousness may play a role in driving early WLST decisions. C. Question What is the value of serum neurofilament light chain measurement for prognosis of outcome after cardiac arrest?. Thirteen percent of patients regained independent function at some point during the first postarrest year. 2. A poor neurological outcome—defined as death from neurological cause, persistent vegetative state, or severe neurological disability—can be predicted in these patients by assessing the severity of HIBI. The 2006 American Academy of Neurology (AAN) practice parameter for prediction of outcome in comatose survivors after CPR provides useful prognostication guidelines ; however, these guidelines were based on studies performed before the use of hypothermia and the authors rightfully urge caution in the interpretation of various prognosticators in Aug 9, 2021 · A definition of irreversible coma: report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. Sep 27, 2023 · This cohort study examines data from the large international CREACTIVE Consortium to gauge whether monitoring intracranial pressure among patients with traumatic brain injury is associated with better short- and mid-term outcomes. Nonconvulsive status epilepticus in coma and duration of status epilepticus were associated with development of new neurological deficits, and a simple 3-factor score (ACD score) combining these 2 risk factors with age at onset was developed to estimate survival after status epilepticus diagnosis. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Mar 16, 2018 · Functional neurological disorders (FND) are among the most common causes of neurological disability. Findings In this cohort study of 484 participants with msTBI, by 12 months postinjury, approximately half of those with severe TBI and three-quarters of those with moderate TBI recovered the ability to function independently at home for at least 8 hours per This secondary analysis of 2 phase 3 clinical trials evaluates 1-year functional recovery among patients with intracerebral and intraventricular hemorrhage and initial severe disability and assesses factors associated with long-term recovery. 1 Approximately 10% of these deaths are due to brain death, and less than 5% die after an attempt at cardiopulmonary resuscitation (CPR). Patients had to be included within 12 hours after return of spontaneous circulation (ROSC). However, a striking exception is presented by the occurrence of alpha coma in acute drug intoxication. Coma prognostication after acute brain injury: A review. 1 These conditions have had a long and difficult history of mind-body dualism and have now reached better-defined pathophysiological and neurobiological bases that challenge old assumptions of psychological abnormalities as their sole cause (in other words, their status as a psychogenic illness). During the past decade, as To the Editor. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. Dr Worrall reported receiving personal fees from the American Academy of Neurology and serving as Deputy Editor for Editorial Education for Neurology. Hofmeijer J, Beernink TM, Bosch FH, Beishuizen A, Tjepkema- Cloostermans MC, van Putten MJ. SSEPs were recorded after targeted temperature management (TTM) for 24 h and clearance of sedative medication. Greer’s research interests include predicting recovery from coma after cardiac arrest, brain death, and multiple stroke-related topics, including acute stroke treatment and stroke prevention. Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. D. resuscitation. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. Neuroprognostication, or the Apr 28, 2022 · Izzy et al. Neurology. Current and Emerging Approaches to Coma Prognostication After Acute Brain Injury A Systematic Review and Meta-Analysis of Randomized Controlled Trials" with JAMA Neurology Web Editor Cynthia Mar 29, 2022 · JAMA Surg. Question How common are persistent, injury-related functional limitations following mild traumatic brain injury vs orthopedic trauma?. Koelman and Janneke Horn Jul 10, 2006 · Objective: To study the impact of neurologic prognostication on the decision to withdraw life-sustaining therapies (LST) in comatose patients resuscitated after cardiac arrest. Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying specifi c attention to appropriate timings and. Mar 4, 2024 · Coma Prognostication After Acute Brain Injury Coma Prognostication After Acute Brain Injury Fischer, David; Edlow, Brian L. 2024-03-04 00:00:00 ImportanceAmong the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute Mar 15, 2022 · Intracerebral hemorrhage (ICH) remains a challenging disease to treat. Key Points. BRAIN INJURY Minimum Criteria for Diagnosis A traumatic injury to the head is of major concern to the individual if there is evidence of brain injury. Findings In this analysis of biobank data from 717 patients at 29 sites, serum neurofilament light chain levels measured at 24 to 72 hours after cardiac arrest were a highly sensitive and specific marker for poor neurologic outcome 6 months later. concluded that TBI of any severity was associated with a higher risk of chronic cardiovascular, endocrine, and neurological comorbidities in patients without baseline diagnoses. Mar 4, 2024 · Conclusions and relevance: Neuroprognostic markers are rapidly evolving as new ways of assessing the brain's structural and functional integrity after brain injury are discovered. Oct 1, 2020 · Importance In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection, but is resource-consuming compared with routine EEG (rEEG). JAMA. eFigure 1. This self-paced CME course—featuring educational activities from content providers including the AMA Journal of Ethics, Science, Medicine and Public Health, JAMA Internal Medicine, JAMA Neurology, JAMA, American Academy of Hospice and Palliative Medicine, JAMA Open Network, JAMA Ophthalmology, JN Learning, JAMA Dermatology, JAMA Physiatry GCS indicates Glasgow Coma Scale; GOSE, Glasgow Outcome Scale-Extended; QOLIBRI-OS, Quality of Life After Brain Injury Scale-Overall Scale; RPQ, Rivermead Post Concussion Symptoms Questionnaire; TBI, traumatic brain injury. @article{vanSoest2021SSEPAA, title={SSEP amplitudes add information for prognostication in postanoxic coma. Sep 3, 2024 · Neurology: Clinical Practice 2024 Notes: In press. This systematic review and meta-analysis evaluates the use of bloodborne brain injury biomarkers for neurologic prognostication in patients with hypoxic Eligible patients were 18 years or older and in a coma after resuscitation for cardiac arrest (Glasgow Coma Scale score ≤8; score range, 3-15, with lower scores indicating worse responses to stimuli). Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury. None have identified a strongly effective treatment, although Key Points. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management). 1968;205:337–40. et al. May 1, 2016 · Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying specific attention to appropriate timings and combination of May 1, 2016 · Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying specific attention to appropriate timings and combination of Jan 1, 2019 · Importance: Prognostication of neurologic outcome after cardiac arrest is an important but challenging aspect of patient therapy management in critical care units. 2-4 A substantial proportion of the inpatient deaths occur in the 5% to 10% of ischemic stroke and 25% to 30% of intracerebral hemorrhage patients who are initially intubated and supported A high impact factor, fast decision time, and wide reach are a few reasons why JAMA Neurology is a valued resource for authors and readers across the field.
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