End-of-life decisions in patients with severe acute brain injury

Marjolein Geurts, Malcolm R Macleod, Ghislaine J M W van Thiel, Jan van Gijn, L Jaap Kappelle, H Bart van der Worp

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Most in-hospital deaths of patients with stroke, traumatic brain injury, or postanoxic encephalopathy after cardiac arrest occur after a decision to withhold or withdraw life-sustaining treatments. Decisions on treatment restrictions in these patients are generally complex and are based only in part on evidence from published work. Prognostic models to be used in this decision-making process should have a strong discriminative power. However, for most causes of acute brain injury, prognostic models are not sufficiently accurate to serve as the sole basis of decisions to limit treatment. These decisions are also complicated because patients often do not have the capacity to communicate their preferences. Additionally, surrogate decision makers might not accurately represent the patient's preferences. Finally, in the acute stage, prediction of how a patient would adapt to a life with major disability is difficult.

Original languageEnglish
Pages (from-to)515-24
Number of pages10
JournalLancet Neurology
Issue number5
Early online date25 Mar 2014
Publication statusPublished - May 2014

Keywords / Materials (for Non-textual outputs)

  • Brain Injuries
  • Decision Making
  • Humans
  • Terminally Ill
  • Withholding Treatment


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