PT -期刊文章盟艾德琳戈斯AU -康妮Ge盟女巫克劳福德AU - Kelsey Goostrey盟Praewpannanrai Buddadhumaruk盟——凯瑟琳·l·脚腕AU -伯纳德•罗盟-香农卡森盟杰Steingrub AU -道格拉斯·b·白盟Susanne Muehlschlegel TI -预后语言关键神经系统疾病:一项多中心- 10.1212 / WNL混合方法研究援助。0000000000207462 DP - 2023 6月08年TA -神经病半岛投注体育官网学PG - 10.1212 / WNL。0000000000207462 4099 - http://n.半岛投注体育官网neurology.org/content/early/2023/06/08/WNL.0000000000207462.short 4100 - //www.ebmtp.com/content/early/2023/06/08/WNL.0000000000207462.full AB -背景和目标:没有循证指南讨论预后至关重要的神经系统疾病,但总的来说,专家建议临床医生沟通使用估计预后,如数值或定性的风险。知之甚少如何实际临床医生沟通预后严重神经系统疾病。我们的主要目标是描述临床预后语言用于神经系统疾病至关重要。我们另外探索预后之间语言不同预后是否域(例如,生存,认知)。方法:我们进行了一项多中心横截面混合方法研究分析消除识别信息记录audio-recorded clinician-family会议需要重症监护患者的神经系统疾病(如脑出血、创伤性脑损伤,严重的中风)从七个美国中心。两个程序员分配预后语言类型和域预后的临床预后。预后语言编码的概率(估计的结果发生的可能性,例如,“80%生存”;“她可能会生存”)或non-probabilistic(描述结果没有提供可能性;例如,“她可能活不下去”)。 We applied univariate and multivariable binomial logistic regression to examine independent associations between prognostic language and domain of prognosis.Results: We analyzed 43 clinician-family meetings for 39 patients with 78 surrogates and 27 clinicians. Clinicians made 512 statements about survival (median 0/meeting [IQR 0;2]), physical function (median 2[IQR 0;7]), cognition (median 2[IQR 0;6]) and overall recovery (median 2[IQR 1;4]). Most statements were non-probabilistic (316/512 [62%]), 10/512(2%) of prognostic statements offered numeric estimates, and 21% (9/43) of family meetings only contained nonprobabilistic language. Compared to statements about cognition, statements about survival (OR 2.50[95% CI 1.01, 6.18]; p=0.048) and physical function (OR 3.22[1.77, 5.86]; p<0.001) were more frequently probabilistic. Statements about physical function were less likely to be uncertainty-based than statements about cognition (OR 0.34 [95% CI 0.17-0.66]; p=0.002).Discussion: Clinicians preferred not to use estimates (either numeric or qualitative) when discussing critical neurologic illness prognosis, especially when they discussed cognitive outcomes. These findings may inform interventions to improve prognostic communication in critical neurologic illness.