Multimodal assessment improves neuroprognosis performance in clinically unresponsive critical-care patients with brain injury

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.

B. Rohaut, C. Calligaris, B. Hermann, P. Perez, F. Faugeras, F. Raimondo, J.-R. King, D. Engemann, C. Marois, L. Le Guennec, L. Di Meglio, A. Sangaré, M. O. Habert, V. Lambrecq, M. Valente, A. Ben Salah, A. Demertzi, L. Belloli, D. Manasova, L. Jodaitis, M. O. Munoz Musat, N. Pyatigorskaya, D. Galanaud, L. Puybasset, N. Weiss, S. Demeret, F. X. Lejeune, J. D. Sitt, L. Naccache