AAN 2019—Post-cardiac-arrest neuroprognostication: Physicians often lack confidence


  • Daniel M. Keller, Ph.D
  • Actualités des congrès
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Takeaway

  • Many clinicians lack the confidence to accurately predict patients’ neurological outcomes post-cardiac arrest.
  • The main source of knowledge in this area was peers and not an academic resource.

Why this matters

  • Results have implications for care and making end-of-life decisions with families, suggesting the need for an easily referenced resource for prognostication by providers.

Key results

  • 48 (29%) questionnaire responses received.
  • 35% of clinicians expressed discomfort with their post-cardiac-arrest neuroprognostication (PCANP) practice or training (41%).
  • Non-neurologists less comfortable/satisfied with PCANP practice/training vs neurologists (P=.041).
  • Nonattendings less comfortable/satisfied vs attendings (P=.002).
  • Sources of PCANP knowledge: peers 77%, UpToDate 35%, review article 31%, didactic lecture 19%, continuing education lecture 13%.
  • Providers often said they rely on various assessments 1-3 days earlier than a recent guideline suggests.

Study design

  • Link to a questionnaire about PCANP was emailed to attendings, fellows, residents, nurse practitioners, and physician assistants in medical, cardiac, and surgical ICUs and the neurology department at Robert Wood Johnson University Hospital, June-July 2018.
  • 12 questions asked about their understanding and comfort with tests, physical exam assessments, and clinical history used in PCANP.

Limitations

  • Single institution study and small sample size.
  • Respondents were self-selected so they may not have been representative of entire peer cohort.