Prediction of death by neurologic criteria in patients with non-traumatic acute brain injury: a systematic review and meta-analysis.
Daniela Schoene, Marie Nicklas, Eyad Altarsha et al.
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In 30 seconds
This systematic review and meta-analysis examined predictors of death by neurologic criteria (DNC) after non-traumatic acute brain injury. Eighteen studies included reported cohorts of 9,070 participants, but only four studies (n=1,738) contributed to quantitative synthesis. In stroke cohorts, CT markers of severe intracranial mass effect were associated with higher odds of DNC (pooled OR 3.14, 95%CI 1.98-4.96; p<0.0001; I2=0%). In post-cardiac arrest cohorts, lower gray-white matter ratios were associated with progression to DNC. The authors judged the evidence limited and methodologically heterogeneous.
Key findings
- In stroke cohorts, CT markers of severe intracranial mass effect were associated with DNC (pooled OR 3.14, 95%CI 1.98-4.96; p<0.0001; I2=0%).
- In post-cardiac arrest cohorts, lower gray-white matter ratio values were associated with progression to DNC (pooled mean difference -0.15, 95%CI -0.22 to -0.07; p<0.001; I2=72%).
- Only four studies (n=1,738) contributed to quantitative synthesis, from a review including 18 studies and reported cohorts of 9,070 participants.
Why it matters
Recognising imaging features associated with progression to DNC may help clinicians interpret the severity of acute brain injury and inform prognostic assessment. However, the findings do not establish that these markers can reliably predict DNC in individual patients: the quantitative evidence came from few studies, and the authors describe the overall literature as limited and heterogeneous.
What to keep in mind
Only four studies provided comparable data for quantitative synthesis; the evidence was methodologically heterogeneous, and the post-cardiac arrest gray-white matter ratio analysis had substantial heterogeneity (I2=72%).