Prognostication in critically ill patients with severe acute brain injury

Severe acute brain injury (SABI) is a major cause of mortality and long-term disability among patients admitted to the intensive care unit (ICU). One of the greatest challenges in managing these patients is determining their potential for neurological recovery. This thesis evaluates current clinical care for SABI patients and explores several promising tools to improve neuroprognostication.
The research highlights the value of bedside assessments, such as consciousness scales, showing that newer tools like the FOUR score and SECONDs may offer advantages over the widely used Glasgow Coma Scale in specific phases of care. It also demonstrates that electroencephalography (EEG), particularly when combined with standardized reactivity testing, holds potential not only for detecting seizures but also for supporting outcome prediction. In addition, the thesis investigates blood-based biomarkers, identifying early differences between survivors and non-survivors, while emphasizing the need for further validation. Importantly, this work underscores that no single modality is sufficient on its own. It advocates for a multimodal approach that combines clinical examination, EEG, blood-based biomarkers, and advanced imaging techniques to improve accuracy. By identifying current gaps in knowledge and practice, this thesis contributes to the development of more reliable prognostic strategies, ultimately aiming to support better-informed clinical decisions and improve outcomes for patients with severe brain injury.