To Treat or Not to Treat: Early Withdrawal of Therapy and the Limits of Prognostic Ability

The development of computed tomography (CT), simple classifications of the severity of traumatic brain injury such as the Glasgow Coma Scale, monitoring of intracranial pressure, and the concept of prevention of secondary brain injury have helped advance the ability to prognosticate and improve outcomes after traumatic brain injury. However, the art of determining prognosis after severe traumatic brain injury remains imprecise in many situations, leading to controversy over which patients may benefit from aggressive treatment and which patients may suffer futile outcomes despite intervention. A 2005 survey found that 80% of physicians thought that an accurate prognostic assessment was required for decisions on whether or not to withdraw treatment, but only around a third felt that they could accurately assess prognosis.