Management of Perceived Devastating Brain Injury After Hospital Admission: A Consensus Statement
Accurate prognostication in life threatening brain injury is difficult, particularly at an early stage. The eventual outcome for such patients is often death or survival with severe disability. Controlled studies to provide evidence to guide decision making are few and the risk of a ‘self-fulfilling prophecy’, with early prognostication leading to early WLST and death, continues to exist.
The Joint Standards Committee of the Faculty of Intensive Care Medicine and the Intensive Care Society convened a consensus group with representation from stakeholder professional organisations to produce this guidance. It recognised that the weak evidence base makes GRADE guidelines difficult to justify. We have made twelve practical, pragmatic recommendations we hope will help clinicians deliver safe, effective, equitable and justifiable care within a resource constrained NHS.
In the situation where patient centred outcomes are recognised to be unacceptable, regardless of the extent of neurological improvement, then early transition to palliative care without admission to ICU would be appropriate. This consensus statement is intended to apply where the primary pathology is DBI, rather than to the situation where DBI has compounded a progressive and irreversible deterioration in other life threatening co-morbidities.
For the purpose of this statement DBI is defined as 'any neurological condition that is assessed at the time of hospital admission as an immediate threat to life or incompatible with good functional recovery AND where early limitation or withdrawal of therapy is being considered'.