Impact of MRI on decision-making in ICU patients with disorders of consciousness

Simon S. Albrechtsen, Robert G.C. Riis, Moshgan Amiri, Gry Tanum, Ove Bergdal, Morten Blaabjerg, Claus Z. Simonsen, Daniel Kondziella*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Recovery of consciousness is the most important survival factor in patients with acute brain injury and disorders of consciousness (DoC). Since most deaths in the intensive care unit (ICU) occur after withdrawal of life-support, medical decision-making is crucial for acute DoC patients. Neuroimaging informs decision-making, yet the precise effects of MRI on decision-making in the ICU are poorly understood. We investigated the impact of brain MRI on prognostication, therapeutic decisions and physician confidence in ICU patients with DoC. Methods: In this simulated decision-making study utilizing a prospective ICU cohort, a panel of neurocritical experts first reviewed clinical information (without MRI) from 75 acute DoC patients and made decisions about diagnosis, prognosis and treatment. Following review of the MRI, the panel then decided if the initial decisions needed revision. In parallel, a blinded neuroradiologist reassessed all neuroimaging. Results: MRI led to changes in clinical management of 57 (76%) of patients (Number-Needed-to-Test for any change: 1.32), including revised diagnoses (20%), levels of care (21%), diagnostic confidence (43%) and prognostications (33%). Decisions were revised more often with stroke than with other brain injuries (p = 0.02). However, although MRI revealed additional pathology in 81%, this did not predict revised clinical decision-making (p-values ≥0.08). Conclusion: MRI results changed decision-making in 3 of 4 ICU patients, but radiological findings were not predictive of clinical decision-making. This highlights the need to better understand the effects of neuroimaging on management decisions. How MRI influences decision-making in the ICU is an important avenue for research to improve acute DoC management.

Original languageEnglish
Article number113729
JournalBehavioural Brain Research
Volume421
ISSN0166-4328
DOIs
Publication statusPublished - 12. Mar 2022

Bibliographical note

Publisher Copyright:
© 2022

Keywords

  • Cardiac arrest
  • Coma
  • Prognostication
  • Stroke
  • Subarachnoid hemorrhage
  • Traumatic brain injury
  • Unresponsive wakefulness syndrome
  • Vegetative state

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