TY - JOUR
T1 - Review Paper on Penetrating Brain Injury
T2 - Ethical Quandaries in the Trauma Bay and beyond
AU - Zakrison, Tanya L.
AU - Essig, Rachael
AU - Polcari, Ann
AU - McKinley, William
AU - Arnold, Damon
AU - Beyene, Robel
AU - Wilson, Kenneth
AU - Rogers, Selwyn
AU - Matthews, Jeffrey B.
AU - Millis, J. Michael
AU - Angelos, Peter
AU - O'Connor, Michael
AU - Mansour, Ali
AU - Goldenberg, Fernando
AU - Spiegel, Thomas
AU - Horowitz, Peleg
AU - Das, Paramita
AU - Slidell, Mark
AU - Chokshi, Nikunj
AU - Okeke, Iheoma
AU - Barth, Rolf
AU - Wilkins, Harry E.
AU - Kass-Hout, Tareq
AU - Lazaridis, Christos
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Objective: The aim of this review was to review the ethical and multidisciplinary clinical challenges facing trauma surgeons when resuscitating patients presenting with penetrating brain injury (PBI) and multicavitary trauma. Background: While there is a significant gap in the literature on managing PBI in patients presenting with multisystem trauma, recent data demonstrate that resuscitation and prognostic features for such patients remains poorly described, with trauma guidelines out of date in this field. Methods: We reviewed a combination of recent multidisciplinary evidence-informed guidelines for PBI and coupled this with expert opinion from trauma, neurosurgery, neurocritical care, pediatric and transplant surgery, surgical ethics and importantly our community partners. Results: Traditional prognostic signs utilized in traumatic brain injury may not be applicable to PBI with a multidisciplinary team approach suggested on a case-by-case basis. Even with no role for neurosurgical intervention, neurocritical care, and neurointerventional support may be warranted, in parallel to multicavitary operative intervention. Special considerations should be afforded for pediatric PBI. Ethical considerations center on providing the patient with the best chance of survival. Consideration of organ donation should be considered as part of the continuum of patient, proxy and family-centric support and care. Community input is crucial in guiding decision making or protocol establishment on an institutional level. Conclusions: Support of the patient after multicavitary PBI can be complex and is best addressed in a multidisciplinary fashion with extensive community involvement.
AB - Objective: The aim of this review was to review the ethical and multidisciplinary clinical challenges facing trauma surgeons when resuscitating patients presenting with penetrating brain injury (PBI) and multicavitary trauma. Background: While there is a significant gap in the literature on managing PBI in patients presenting with multisystem trauma, recent data demonstrate that resuscitation and prognostic features for such patients remains poorly described, with trauma guidelines out of date in this field. Methods: We reviewed a combination of recent multidisciplinary evidence-informed guidelines for PBI and coupled this with expert opinion from trauma, neurosurgery, neurocritical care, pediatric and transplant surgery, surgical ethics and importantly our community partners. Results: Traditional prognostic signs utilized in traumatic brain injury may not be applicable to PBI with a multidisciplinary team approach suggested on a case-by-case basis. Even with no role for neurosurgical intervention, neurocritical care, and neurointerventional support may be warranted, in parallel to multicavitary operative intervention. Special considerations should be afforded for pediatric PBI. Ethical considerations center on providing the patient with the best chance of survival. Consideration of organ donation should be considered as part of the continuum of patient, proxy and family-centric support and care. Community input is crucial in guiding decision making or protocol establishment on an institutional level. Conclusions: Support of the patient after multicavitary PBI can be complex and is best addressed in a multidisciplinary fashion with extensive community involvement.
KW - ethics
KW - multicavitary trauma
KW - penetrating brain injury
KW - structural racism
KW - transplant
UR - http://www.scopus.com/inward/record.url?scp=85145335943&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85145335943&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000005608
DO - 10.1097/SLA.0000000000005608
M3 - Article
C2 - 35997268
AN - SCOPUS:85145335943
SN - 0003-4932
VL - 277
SP - 66
EP - 72
JO - Annals of surgery
JF - Annals of surgery
IS - 1
ER -