Grant: CIHR New Investigator

Traumatic brain injury is the leading cause of death and severe disabilities among adults under 45 years of age. Most deaths following severe traumatic brain injury are related with the decision made by families and medical teams to withdraw life-sustaining therapies. Because severe traumatic brain injury occurs mainly in a young healthy population, this decision is likely to be based on the perception of an unfavorable long-term outcome. However, recent practice guidelines and current knowledge showed that our capacity to accurately predict outcome in this population is limited. Our prior work showed a significant variation in the frequency of life-sustaining therapy withdrawals across Canadian trauma centers. More importantly, a significant proportion of deaths occurred in the first 3 days, a time-period considered by several experts as being relatively premature to accurately predict the patient outcome. The purpose of this program of research is to understand current prognostic measures and tools, to identify the determinants of prognostic evaluation and level of care decisions, and to develop new prognostic approach and tools to help guiding health care professionals, patients and families in the decision making process. This whole program of research will improve our ability to prognosticate and identify patients who will benefit from aggressive care in the acute phase, and help preventing erroneous evaluation of prognosis that could have profound consequences when used to decide to pursue or to withdraw life-sustaining therapies.