[en] Accurately predicting functional outcomes for unresponsive patients with acute brain injury is a medical, scientific and ethical challenge. This prospective study assesses how a multimodal approach combining various numbers of behavioral, neuroimaging and electrophysiological markers affects the performance of outcome predictions. We analyzed data from 349 patients admitted to a tertiary neurointensive care unit between 2009 and 2021, categorizing prognoses as good, uncertain or poor, and compared these predictions with observed outcomes using the Glasgow Outcome Scale-Extended (GOS-E, levels ranging from 1 to 8, with higher levels indicating better outcomes). After excluding cases with life-sustaining therapy withdrawal to mitigate the self-fulfilling prophecy bias, our findings reveal that a good prognosis, compared with a poor or uncertain one, is associated with better one-year functional outcomes (common odds ratio (95% CI) for higher GOS-E: OR = 14.57 (5.70-40.32), P < 0.001; and 2.9 (1.56-5.45), P < 0.001, respectively). Moreover, increasing the number of assessment modalities decreased uncertainty (OR = 0.35 (0.21-0.59), P < 0.001) and improved prognostic accuracy (OR = 2.72 (1.18-6.47), P = 0.011). Our results underscore the value of multimodal assessment in refining neuroprognostic precision, thereby offering a robust foundation for clinical decision-making processes for acutely brain-injured patients. ClinicalTrials.gov registration: NCT04534777 .
Disciplines :
Neurosciences & behavior
Author, co-author :
Rohaut, B ; Sorbonne Université, Paris, France. benjamin.rohaut@sorbonne-universite.fr ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France. benjamin.rohaut@sorbonne-universite.fr ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France. benjamin.rohaut@sorbonne-universite.fr
Calligaris, C; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France ; GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
Hermann, B ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France ; GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
Perez, P ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Faugeras, F; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Raimondo, Federico ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Physiology of Cognition ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
King, J-R ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; Laboratoire des systèmes perceptifs, Département d'études cognitives, École normale supérieure, PSL University, CNRS, Paris, France
Engemann, D ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Marois, C; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Le Guennec, L ; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Di Meglio, L ; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France ; GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Anesthesia and Intensive Care Department, Paris, France
Sangaré, A; Sorbonne Université, Paris, France ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
Munoz Musat, E ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
Valente, M; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Ben Salah, A; Sorbonne Université, Paris, France ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Demertzi, Athina ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Physiology of Cognition ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Belloli, L ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Manasova, D ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Jodaitis, L; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Habert, M O ; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, Departement of Nuclear Medicine, Laboratoire d'Imagerie Biomédicale, Inserm, CNRS, Paris, France
Lambrecq, V ; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
Pyatigorskaya, N; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-radiology, Paris, France
Galanaud, D; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-radiology, Paris, France
Puybasset, L; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, Departement of Neuro-anaesthesiology and Neurocritical care, Paris, France
Weiss, N ; Sorbonne Université, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Demeret, S; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neuro ICU, Paris, France
Lejeune, F X ; Paris Brain Institute - ICM, Inserm, CNRS, Data Analysis Core, Paris, France
Sitt, J D ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France
Naccache, L; Sorbonne Université, Paris, France ; Paris Brain Institute - ICM, Inserm, CNRS, PICNIC-Lab, Paris, France ; APHP, Hôpital de la Pitié Salpêtrière, DMU Neurosciences - Neurophysiology, Paris, France
This work was supported by Sorbonne Universit\u00E9, the James S. McDonnell Foundation, FRM 2015, UNIM, the Acad\u00E9mie des Sciences-Lamonica Prize 2016 (L.N.) and a PerMed grant (J.D.S.). The research leading to these results received funding from the program Investissements d\u2019avenir ANR-10-IAIHU-06. There was no industry involvement in or support for the study. The authors vouch for the accuracy and completeness of the data and for the fidelity of the trial to the protocol.
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