2024
Correction: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data
Jaffa M, Kirsch H, Creutzfeldt C, Guanci M, Hwang D, LeTavec D, Mahanes D, Natarajan G, Steinberg A, Zahuranec D, Muehlschlegel S. Correction: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data. Neurocritical Care 2024, 1-2. PMID: 39407076, DOI: 10.1007/s12028-024-02098-9.Peer-Reviewed Original ResearchGuidelines for Neuroprognostication in Critically Ill Adults with Moderate–Severe Traumatic Brain Injury
Muehlschlegel S, Rajajee V, Wartenberg K, Alexander S, Busl K, Creutzfeldt C, Fontaine G, Hocker S, Hwang D, Kim K, Madzar D, Mahanes D, Mainali S, Meixensberger J, Sakowitz O, Varelas P, Weimar C, Westermaier T. Guidelines for Neuroprognostication in Critically Ill Adults with Moderate–Severe Traumatic Brain Injury. Neurocritical Care 2024, 40: 448-476. PMID: 38366277, PMCID: PMC10959796, DOI: 10.1007/s12028-023-01902-2.Peer-Reviewed Original ResearchTraumatic brain injuryBrain injuryFunctional outcomesSurrogate decision-makersSurrogates of patientsSystematic narrative reviewIMPACT lab modelQuality of evidenceClinical variablesDesirability of outcomesClinically relevant predictorsCritically ill adultsRecommendations AssessmentComfort measuresIn-hospital mortalityConclusionsThese guidelinesMsTBIEligibility criteriaPoor outcomeIll adultsPatient triagePractice recommendationsIndividual predictorsInternational Mission for PrognosisNarrative review
2023
Guidelines for neuroprognostication in adults with traumatic spinal cord injury
Mahanes D, Muehlschlegel S, Wartenberg K, Rajajee V, Alexander S, Busl K, Creutzfeldt C, Fontaine G, Hocker S, Hwang D, Kim K, Madzar D, Mainali S, Meixensberger J, Varelas P, Weimar C, Westermaier T, Sakowitz O. Guidelines for neuroprognostication in adults with traumatic spinal cord injury. Neurocritical Care 2023, 40: 415-437. PMID: 37957419, PMCID: PMC10959804, DOI: 10.1007/s12028-023-01845-8.Peer-Reviewed Original ResearchSpinal cord injuryTraumatic spinal cord injuryCord injuryFunctional outcomeRecommendations AssessmentIndependent ambulationClinical variablesAmerican Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversionBest practice recommendationsPractice recommendationsReliable predictorCandidate clinical variablesPatient-centered prioritiesClinical prediction ruleQuality of evidenceLow-quality studiesGuideline development processAbility of cliniciansSeverity of injuryLong-term qualityFull-text reviewMagnetic resonance imagingTime of assessmentNarrative systematic reviewConclusionsThese guidelinesGuidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage
Hwang D, Kim K, Muehlschlegel S, Wartenberg K, Rajajee V, Alexander S, Busl K, Creutzfeldt C, Fontaine G, Hocker S, Madzar D, Mahanes D, Mainali S, Sakowitz O, Varelas P, Weimar C, Westermaier T, Meixensberger J. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocritical Care 2023, 40: 395-414. PMID: 37923968, PMCID: PMC10959839, DOI: 10.1007/s12028-023-01854-7.Peer-Reviewed Original ResearchClinical grading scaleClinical variablesGrading scaleRecommendations AssessmentPoor outcomeIntensive care unit admissionCandidate clinical variablesCritically Ill AdultsIndividual clinical variablesMajor clinical predictorsCare unit admissionCounseling of patientsBest practice statementsJudgment of prognosisNarrative systematic reviewConclusionsThese guidelinesUnit admissionNeurological recoveryClinical predictorsIll adultsCounseling patientsIntracerebral hemorrhageFunctional outcomeConsensus statementNeuroprognosticationSporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome
Mikhaiel J, Parasram M, Manning T, Al-Dulaimi M, Barnes E, Falcone G, Hwang D, Prust M. Sporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome. The Neurologist 2023, 29: 14-16. PMID: 37582680, DOI: 10.1097/nrl.0000000000000519.Peer-Reviewed Original ResearchConceptsSporadic Creutzfeldt-Jakob diseaseMagnetic resonance imagingReversible encephalopathy syndromeCreutzfeldt-Jakob diseaseEncephalopathy syndromeAntiseizure medicationsLumbar punctureDiagnosis of sCJDFluid-attenuated inversion recovery changesPosterior reversible encephalopathy syndromeRepeat magnetic resonance imagingCases of sCJDPeriodic dischargesMultiple antiseizure medicationsRepeat lumbar punctureStuporous mental stateInitial lumbar punctureInversion recovery hyperintensityNonconvulsive status epilepticusReal-time quaking-induced conversionFatal neurodegenerative conditionProgressive confusionRadiographic improvementNeurological declineStatus epilepticusEmergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa
Ammar A, Elsamadicy A, Ammar M, Reeves B, Koo A, Falcone G, Hwang D, Petersen N, Kim J, Beekman R, Prust M, Magid-Bernstein J, Acosta J, Herbert R, Sheth K, Matouk C, Gilmore E. Emergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa. Clinical Neurology And Neurosurgery 2023, 226: 107621. PMID: 36791588, DOI: 10.1016/j.clineuro.2023.107621.Peer-Reviewed Original ResearchConceptsAndexanet alfaExtra-axial hemorrhageEVD placementThrombotic eventsNew hemorrhagePrimary safety outcomeExternal ventricular drain placementLarge prospective studiesIntensive care unitIntracerebral hemorrhage patientsVentricular drain placementBolus patientsHospital lengthHospital LOSICU LOSTract hemorrhageRankin scoreSecondary outcomesAdult patientsBolus groupPrimary outcomeCare unitIntracerebral hemorrhageLong administration timeHemorrhage patientsImplementation of a Standardized Shared Decision-making Bundle to Improve Communication Practices in the Neurocritical Care Unit
Waseem H, Keegan J, Farrell K, Hwang D, Oliver B, Olm-Shipman C, Pepin R, Mecchella J. Implementation of a Standardized Shared Decision-making Bundle to Improve Communication Practices in the Neurocritical Care Unit. Neurology Clinical Practice 2023, 13: e200120. PMID: 36865641, PMCID: PMC9973293, DOI: 10.1212/cpj.0000000000200120.Peer-Reviewed Original ResearchShared decision-makingSDM conversationsNeurocritical care unitInstitute for Healthcare Improvement's ModelHealth care team membersPlan-Do-Study-Act cyclesPlan-Do-Study-ActCare team membersQuality improvement initiativesElectronic medical recordsPrimary outcome measureInterprofessional teamConsultation ratesSDM practicesIdentified barriersImproved documentationImprovement initiativesLength of stayPatient's familyTeam workflowImprove communicationOutcome measuresPatient preferencesFamily goalsDocumentation tools
2022
Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury
Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach JJ, Hwang DY. Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury. Neurology 2022, 99: e1446-e1455. PMID: 35853748, PMCID: PMC9576301, DOI: 10.1212/wnl.0000000000200937.Peer-Reviewed Original ResearchConceptsCode status changeTraumatic brain injuryBrain injuryIschemic strokeCare decisionsIntracerebral hemorrhageDA groupAcute brain injury patientsSevere acute brain injuryNeurologic intensive care unitCare decision aidSurrogates of patientsAcute brain injuryAcute ischemic strokeClass IV evidenceLong-term prognosisIntensive care unitBrain injury patientsClinician-family communicationAdditional psychosocial supportPatient-centered careLife-sustaining treatmentPsychological outcomesDecision-making interventionClassification of evidencePsychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients
Zhang Q, Knies AK, Pach J, Kimbrough T, Martinez A, Juthani P, Tu S, Monin JK, Vranceanu AM, Hwang DY. Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients. Critical Care Explorations 2022, 4: e0753. PMID: 36050994, PMCID: PMC9426807, DOI: 10.1097/cce.0000000000000753.Peer-Reviewed Original ResearchICU patientsPTSD symptomsICU dischargeHispanic ethnicityFamily meetingsFamily membersICU patients' family membersProspective cohort studyMultiple logistic regressionLong-term PTSD symptomsPatients' family membersHigh-risk categoryLonger-term posttraumatic stress symptomsPosttraumatic stress disorder (PTSD) symptomsNeuroscience ICUEvent Scale-RevisedCohort studyIndependent predictorsPatient characteristicsRisk factorsPatient deathUnivariate analysisPatient covariatesSignificant symptomsPsychologic outcomesCoping Strategies and Psychosocial Resource Needs Reported by Families of Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study (RP423)
Kubota R, Meurer K, Baskaran N, Zhang Q, Bannon S, Fishbein N, Lichstein K, Reichman M, Popok P, Lester E, Motta M, Muehlschlegel S, Reznik M, Jaffa M, Creutzfeldt C, Fehnel C, Freeman W, Williamson C, Vranceanu A, Hwang D. Coping Strategies and Psychosocial Resource Needs Reported by Families of Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study (RP423). Journal Of Pain And Symptom Management 2022, 63: 1095-1096. DOI: 10.1016/j.jpainsymman.2022.04.064.Peer-Reviewed Original ResearchCommon coping strategiesCoping strategiesSevere acute brain injuryPsychosocial resourcesSABI patientsFamily caregiversPsychosocial supportAcute brain injuryNeurointensive care unitFamily support interventionBrain injuryPositive emotionsCare unitPsychological distressYears of collegeSocial supportPersonal social networksGlasgow Coma Scale scorePrimary caregiversTeam membersPrior experienceEffective interventionsInterview transcriptsFamilies of patientsMulticenter qualitative studyTop Ten Tips Palliative Care Clinicians Should Know About Disorders of Consciousness: A Focus on Traumatic and Anoxic Brain Injury
Steinberg A, Hudoba C, Hwang DY, Kramer NM, Mehta AK, Muehlschlegel S, Jones CA, Besbris J. Top Ten Tips Palliative Care Clinicians Should Know About Disorders of Consciousness: A Focus on Traumatic and Anoxic Brain Injury. Journal Of Palliative Medicine 2022, 25: 1571-1578. PMID: 35639356, DOI: 10.1089/jpm.2022.0202.Peer-Reviewed Original ResearchEffect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation
Bösel J, Niesen WD, Salih F, Morris NA, Ragland JT, Gough B, Schneider H, Neumann JO, Hwang DY, Kantamneni P, James ML, Freeman WD, Rajajee V, Rao CV, Nair D, Benner L, Meis J, Klose C, Kieser M, Suarez JI, Schönenberger S, Seder DB, Ramadan A, Claassen J, Mayer S, Peled H, Christianson T, May T, Riker R, Asgarpur G, Stetefeld H, Kluge S. Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation. JAMA 2022, 327: 1899-1909. PMID: 35506515, PMCID: PMC9069344, DOI: 10.1001/jama.2022.4798.Peer-Reviewed Original ResearchConceptsEarly tracheostomy groupEarly tracheostomyMechanical ventilationSevere strokeFunctional outcomeStandard tracheostomyTracheostomy groupPrimary outcomeControl groupProlonged invasive mechanical ventilationModified Rankin Scale scoreSevere disabilityInvasive mechanical ventilationSerious adverse eventsRankin Scale scoreAirway protective reflexesRate of survivalInvasive ventilationAdverse eventsHemorrhagic strokeWide confidence intervalsAvailable followProtective reflexesCare centerClinical trialsStressors Experienced by Primary Caregivers of Severe Acute Brain Injury Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study (P1-4.009)
Meurer K, Kubota R, Baskaran N, Zhang Q, Bannon S, Fishbein N, Reichman M, Popok P, Lester E, Motta M, Muehlschlegel S, Reznik M, Jaffa M, Creutzfeldt C, Fehnel C, Williamson C, Vranceanu A, Hwang D, Investigators C. Stressors Experienced by Primary Caregivers of Severe Acute Brain Injury Patients Recovering from Coma in Neurointensive Care Units: Preliminary Findings from a Multicenter Qualitative Study (P1-4.009). Neurology 2022, 98 DOI: 10.1212/wnl.98.18_supplement.3641.Peer-Reviewed Original Research
2021
End-of-Life Care Decision-Making in Stroke
Gao L, Zhao C, Hwang D. End-of-Life Care Decision-Making in Stroke. Frontiers In Neurology 2021, 12: 702833. PMID: 34650502, PMCID: PMC8505717, DOI: 10.3389/fneur.2021.702833.Peer-Reviewed Original ResearchStroke patientsImmediate post-stroke periodIntensive care unit careLong-term functional outcomeCare decisionsCode status changePost-stroke periodIntensive care unitIntracerebral hemorrhage patientsLong-term disabilityLife care discussionsLife-sustaining therapyCause of deathLife care decisionsClinician's subjectivityIschemic strokeUnit careCare unitHemorrhage patientsPatient survivalFunctional outcomeProvider recommendationPatient preferencesCare discussionsTreatment goalsFrequency of Withdrawal of Life-Sustaining Therapy for Perceived Poor Neurologic Prognosis
Steinberg A, Abella BS, Gilmore EJ, Hwang DY, Kennedy N, Lau W, Mullen I, Ravishankar N, Tisch CF, Waddell A, Wallace DJ, Zhang Q, Elmer J. Frequency of Withdrawal of Life-Sustaining Therapy for Perceived Poor Neurologic Prognosis. Critical Care Explorations 2021, 3: e0487. PMID: 34278317, PMCID: PMC8280080, DOI: 10.1097/cce.0000000000000487.Peer-Reviewed Original ResearchPoor neurologic prognosisLife-sustaining therapyLarge teaching hospitalNeurologic prognosisOdds of withdrawalFrequency of withdrawalSmall Teaching HospitalTeaching hospitalMedian hospital lengthPrimary neurologic diagnosisRetrospective cohort studyRate of withdrawalInpatient decedentsHospital lengthInpatient deathCardiac deathCohort studyMedian ageHospital variabilitySignificant unexplained variationHospital characteristicsNeurologic diagnosisBrain deathNonteaching hospitalsHospital settingPsychological attachment orientations and long-term post-traumatic stress symptoms among family members of neurointensive care unit patients (2120)
Zhang Q, Knies A, Pach J, Kimbrough T, Martinez A, Juthani P, Tu S, Monin J, Hwang D. Psychological attachment orientations and long-term post-traumatic stress symptoms among family members of neurointensive care unit patients (2120). Neurology 2021, 96 DOI: 10.1212/wnl.96.15_supplement.2120.Peer-Reviewed Original ResearchA Two-Center, Parallel-Arm Randomized-Controlled Feasibility Trial Of A Goals-Of-Care Decision Aid For Surrogates Of Severe Acute Brain Injury Patients (2288)
Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach J, Hwang D. A Two-Center, Parallel-Arm Randomized-Controlled Feasibility Trial Of A Goals-Of-Care Decision Aid For Surrogates Of Severe Acute Brain Injury Patients (2288). Neurology 2021, 96 DOI: 10.1212/wnl.96.15_supplement.2288.Peer-Reviewed Original ResearchRace/ethnicity and Insurance Status Impact Acute Ischemic Stroke Treatment within Three Large U.S. States (2968)
Herman A, Kuohn L, Falcone G, Sharma R, Hwang D, Sheth K, Kim J. Race/ethnicity and Insurance Status Impact Acute Ischemic Stroke Treatment within Three Large U.S. States (2968). Neurology 2021, 96 DOI: 10.1212/wnl.96.15_supplement.2968.Peer-Reviewed Original ResearchLow-Field, Portable Magnetic Resonance Imaging at the Bedside to Assess Brain Injury in Patients with Severe COVID-19 (1349)
Mazurek M, Yuen M, Cahn B, Rosen M, Gobeske K, Gilmore E, Hwang D, Kaddouh F, Kim J, Falcone G, Petersen N, Siner J, Spudich S, Sze G, Kimberly W, Sheth K. Low-Field, Portable Magnetic Resonance Imaging at the Bedside to Assess Brain Injury in Patients with Severe COVID-19 (1349). Neurology 2021, 96 DOI: 10.1212/wnl.96.15_supplement.1349.Peer-Reviewed Original ResearchPredictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making
Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Vranceanu AM, Rosand J, Hwang DY. Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making. Neurocritical Care 2021, 35: 714-722. PMID: 33821402, PMCID: PMC8021441, DOI: 10.1007/s12028-021-01211-6.Peer-Reviewed Original ResearchConceptsFormal family meetingsICU admissionFamily meetingsNeuro-ICURetrospective observational cohort studyObservational cohort studyUS academic centersFamilies of patientsBroad inclusion criteriaFamily satisfactionTop-box responsesFamily membersNeuroscience ICUICU dischargeICU courseCohort studyIll patientsAvailable patientsPatient variablesFamily dissatisfactionInclusion criteriaPatientsAcademic centersPatient lengthAverage patient length