Prediction by clinical nurses of outcome in patients with traumatic brain injury.

The spectrum of traumatic brain injuries (TBI) is wide, ranging from minor concussions to major contusions. This heterogeneity of TBI encompasses a lot of uncertainty about the likelihood of worsening or improvement in individual patients. Predicting the outcome of individual patients with traumatic brain injury is therefore challenging. The objective of the study was to determine the accuracy of prediction of outcome in patients with TBI by clinical nurses in comparison to predictions made by a well-validated prognostic model, the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model. A survey was conducted among 50 nurses working in an acute neurotrauma setting in a tertiary care hospital. Some 10 case vignettes describing the clinical data of patients with TBI were given to clinical nurses. The nurses were asked to predict the chance of mortality and unfavorable outcome (unfavorable outcome defined as mortality, vegetative state or severe disability with complete dependence for all physical needs) at 6 months for each case. Predictions made by nurses were compared to predictions made by the IMPACT prognostic calculator for each case. A total of 50 responses were used for analysis. The prognostication made by nurses differed significantly from the IMPACT score. The difference in prediction (expressed as a percentage) ranged from -6.3± 29.6 to 42± 20.5. For most of the cases, nurses tended to be more pessimistic about the outcome. The study provides an insight into the nurses' perception regarding outcome in patients with TBI. It also elucidates the importance of promoting the usage of prognostic models by nurses. [ABSTRACT FROM AUTHOR]