Critical Neurotrauma Decision Making

News Update

Critical Neurotrauma Decision Making

Date

November 7, 2017
Presenters at the Congress of Neurological Surgeons

Theresa Williamson, MDMary Carol Barks, and a team of Duke medical students recently surveyed 140 neurosurgeons at the annual Congress of Neurological Surgeons meeting on October 8th-11th in Boston, MA as part of a research study to understand how neurosurgeons make the emergent and complex decisions to operate on patients that present with severe traumatic brain injury.

Dr. Williamson, a 4th year neurosurgery resident at Duke, designed the survey (mentored by Peter Ubel, MD) based on her experience as a resident, where she asks attending neurosurgeons prognostic and surgical advice before treating patients requiring emergency medical intervention. Treating TBI patients often requires heart-breaking discussions with distressed families since patients are unable to communicate for themselves.

The survey presented neurosurgeons with two scenarios, each featuring a previously independent man who arrives at the emergency room comatose due to severe brain injury. Based on each scenario’s limited clinical and prognostic information, neurosurgeons were asked to make a treatment decision for each patient:  1. operate, 2. admit to the ICU for aggressive medical management, or 3. initiate comfort care measures.

Following this decision, neurosurgeons were then asked to prognosticate the health states of patients with clinically similar conditions following surgical intervention – for example, what percentage of patients will survive six months post-operation? Dr. Williamson also designed half of the surveys to include a CRASH calculator – a prognostic tool that predicts TBI patient health outcomes – to evaluate whether it influenced neurosurgeon prognostication and the decision to operate.

Dr. Williamson hopes neurotrauma decision making research will help neurosurgeons navigate the limited prognostic information and challenging treatment decisions involved in caring for patients with severe TBI.  Future research includes evaluating underlying neurosurgeon attitudes towards decision making, and analyzing available data on health outcomes by treatment choice, to inform practice and education policies.