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Erschienen in: Neurocritical Care 1/2014

01.08.2014 | Original Article

DESTINY-S: Attitudes of Physicians Toward Disability and Treatment in Malignant MCA Infarction

verfasst von: Hermann Neugebauer, Claire J. Creutzfeldt, J. Claude Hemphill III, Peter U. Heuschmann, Eric Jüttler

Erschienen in: Neurocritical Care | Ausgabe 1/2014

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Abstract

Background

Decompressive hemicraniectomy (DHC) reduces mortality and improves outcome after malignant middle cerebral artery (MCA) infarction but leaves a high number of survivors severely disabled. Attitudes among physicians toward the degree of disability that is considered acceptable and the impact of aphasia may play a major role in treatment decisions.

Methods

DESTINY-S is a multicenter, international, cross-sectional survey among 1,860 physicians potentially involved in the treatment of malignant MCA infarction. Questions concerned the grade of disability, the hemisphere of the stroke, and the preferred treatment for malignant MCA infarction.

Results

mRS scores of 3 or better were considered acceptable by the majority of respondents (79.3 %). Only few considered a mRS score of 5 still acceptable (5.8 %). A mRS score of 4 was considered acceptable by 38.0 %. Involved hemisphere (dominant vs. non-dominant) was considered a major clinical symptom influencing treatment decisions in 47.7 % of respondents, also reflected by significantly different rates for DHC as preferred treatment in dominant versus non-dominant hemispheric infarction (46.9 vs. 72.9 %). Significant differences in acceptable disability and treatment decisions were found among geographic regions, medical specialties, and respondents with different work experiences.

Conclusion

Little consensus exists among physicians regarding acceptable outcome and therapeutic management after malignant MCA infarction, and physician’s recommendations do not correlate with available evidence. We advocate for a decision-making process that balances scientific evidence, patient preference, and clinical expertise.
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Literatur
1.
Zurück zum Zitat Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309–15.PubMedCrossRef Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309–15.PubMedCrossRef
2.
Zurück zum Zitat Hofmeijer J, Kapelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.PubMedCrossRef Hofmeijer J, Kapelle LJ, Algra A, et al. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.PubMedCrossRef
3.
Zurück zum Zitat Jüttler E, Schwab S, Schmiedek P, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomised, controlled trial. Stroke. 2007;38:2518–25.PubMedCrossRef Jüttler E, Schwab S, Schmiedek P, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomised, controlled trial. Stroke. 2007;38:2518–25.PubMedCrossRef
4.
Zurück zum Zitat Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomised, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38:2506–17.PubMedCrossRef Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomised, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38:2506–17.PubMedCrossRef
5.
Zurück zum Zitat Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant middle cerebral artery infarction: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.PubMedCrossRef Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant middle cerebral artery infarction: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.PubMedCrossRef
6.
Zurück zum Zitat Puetz V, Campos CR, Eliasziw M, Hill MD, Demchuk AM. Calgary Stroke Program. Assessing the benefits of hemicraniectomy: what is a favourable outcome? Lancet Neurol. 2007;6:580.PubMedCrossRef Puetz V, Campos CR, Eliasziw M, Hill MD, Demchuk AM. Calgary Stroke Program. Assessing the benefits of hemicraniectomy: what is a favourable outcome? Lancet Neurol. 2007;6:580.PubMedCrossRef
7.
Zurück zum Zitat European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507.CrossRef European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507.CrossRef
8.
Zurück zum Zitat Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.PubMedCrossRef Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.PubMedCrossRef
9.
Zurück zum Zitat Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.PubMedCrossRef Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.PubMedCrossRef
10.
Zurück zum Zitat No authors listed. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333:1581–7. No authors listed. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333:1581–7.
11.
Zurück zum Zitat Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358:2127–37.PubMedCrossRef Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358:2127–37.PubMedCrossRef
12.
Zurück zum Zitat Vahedi K, Hofmeijer J, Juettler E, et al. Assessing the benefits of hemicraniectomy: what is a favourable outcome?—Authors’s reply. Lancet Neurol. 2007;6:580–1.CrossRef Vahedi K, Hofmeijer J, Juettler E, et al. Assessing the benefits of hemicraniectomy: what is a favourable outcome?—Authors’s reply. Lancet Neurol. 2007;6:580–1.CrossRef
13.
Zurück zum Zitat New PW, Buchbinder R. Critical appraisal and review of the Rankin scale and its derivatives. Neuroepidemiology. 2006;26:4–15.PubMedCrossRef New PW, Buchbinder R. Critical appraisal and review of the Rankin scale and its derivatives. Neuroepidemiology. 2006;26:4–15.PubMedCrossRef
14.
Zurück zum Zitat World Health Organization. International Classification of Functioning, Disability and Health (ICF). October 2005; Geneva. World Health Organization. International Classification of Functioning, Disability and Health (ICF). October 2005; Geneva.
15.
Zurück zum Zitat Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999;48:977–88.PubMedCrossRef Albrecht GL, Devlieger PJ. The disability paradox: high quality of life against all odds. Soc Sci Med. 1999;48:977–88.PubMedCrossRef
16.
Zurück zum Zitat Creutzfeldt CJ, Holloway RG. Treatment decisions after severe stroke: uncertainty and biases. Stroke. 2012;43:3405–8.PubMedCrossRef Creutzfeldt CJ, Holloway RG. Treatment decisions after severe stroke: uncertainty and biases. Stroke. 2012;43:3405–8.PubMedCrossRef
17.
Zurück zum Zitat Quill TE, Holloway RG. Evidence, preferences, recommendations—finding the right balance in patient care. N Engl J Med. 2012;366:1653–5.PubMedCrossRef Quill TE, Holloway RG. Evidence, preferences, recommendations—finding the right balance in patient care. N Engl J Med. 2012;366:1653–5.PubMedCrossRef
18.
Zurück zum Zitat Nakagawa K, Bianchi MT, Nakagawa SS, Sorond FA. Aggressive care after a massive stroke in young patients: is that what they want? Neurocrit Care. 2010;13:118–22.PubMedCentralPubMedCrossRef Nakagawa K, Bianchi MT, Nakagawa SS, Sorond FA. Aggressive care after a massive stroke in young patients: is that what they want? Neurocrit Care. 2010;13:118–22.PubMedCentralPubMedCrossRef
19.
Zurück zum Zitat Walz B, Zimmermann C, Böttger S, Haberl RL. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol. 2002;249:1183–90.PubMedCrossRef Walz B, Zimmermann C, Böttger S, Haberl RL. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol. 2002;249:1183–90.PubMedCrossRef
20.
Zurück zum Zitat Woertgen C, Erban P, Rothoerl RD, Bein T, Horn M, Brawanski A. Quality of life after decompressive craniectomy in patients suffering from supratentorial brain ischemia. Acta Neurochir (Wien). 2004;146:691–5. Woertgen C, Erban P, Rothoerl RD, Bein T, Horn M, Brawanski A. Quality of life after decompressive craniectomy in patients suffering from supratentorial brain ischemia. Acta Neurochir (Wien). 2004;146:691–5.
21.
Zurück zum Zitat Kiphuth IC, Köhrmann M, Lichy C, Schwab S, Huttner HB. Hemicraniectomy for malignant middle cerebral artery infarction: retrospective consent to decompressive surgery depends on functional long-term outcome. Neurocrit Care. 2010;13:380–4.PubMedCrossRef Kiphuth IC, Köhrmann M, Lichy C, Schwab S, Huttner HB. Hemicraniectomy for malignant middle cerebral artery infarction: retrospective consent to decompressive surgery depends on functional long-term outcome. Neurocrit Care. 2010;13:380–4.PubMedCrossRef
22.
Zurück zum Zitat Benejam B, Sahuquillo J, Poca MA, et al. Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. J Neurol. 2009;256:1126–33.PubMedCrossRef Benejam B, Sahuquillo J, Poca MA, et al. Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. J Neurol. 2009;256:1126–33.PubMedCrossRef
23.
Zurück zum Zitat von Sarnowski B, Kleist-Welch Guerra W, Kohlmann T, et al. Long-term health-related quality of life after decompressive hemicraniectomy in stroke patients with life-threatening space-occupying brain edema. Clin Neurol Neurosurg. 2012;114:627–33.CrossRef von Sarnowski B, Kleist-Welch Guerra W, Kohlmann T, et al. Long-term health-related quality of life after decompressive hemicraniectomy in stroke patients with life-threatening space-occupying brain edema. Clin Neurol Neurosurg. 2012;114:627–33.CrossRef
24.
Zurück zum Zitat Leonhardt G, Wilhelm H, Doerfler A, et al. Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction. J Neurol. 2002;249:1433–40.PubMedCrossRef Leonhardt G, Wilhelm H, Doerfler A, et al. Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction. J Neurol. 2002;249:1433–40.PubMedCrossRef
25.
Zurück zum Zitat Foerch C, Lang JM, Krause J, et al. Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Neurosurg. 2004;101:248–54.PubMedCrossRef Foerch C, Lang JM, Krause J, et al. Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction. J Neurosurg. 2004;101:248–54.PubMedCrossRef
26.
Zurück zum Zitat Vahedi K, Benoist L, Kurtz A, et al. Quality of life after decompressive craniectomy for malignant middle cerebral artery infarction. J Neurol Neurosurg Psychiatry. 2005;76:1181–2.PubMedCentralPubMedCrossRef Vahedi K, Benoist L, Kurtz A, et al. Quality of life after decompressive craniectomy for malignant middle cerebral artery infarction. J Neurol Neurosurg Psychiatry. 2005;76:1181–2.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke. 2004;35:539–43.PubMedCrossRef Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke. 2004;35:539–43.PubMedCrossRef
28.
Zurück zum Zitat Weil AG, Rahme R, Moumdjian R, Bouthillier A, Bojanowski MW. Quality of life following hemicraniectomy for malignant MCA territory infarction. Can J Neurol Sci. 2011;38:434–8.PubMed Weil AG, Rahme R, Moumdjian R, Bouthillier A, Bojanowski MW. Quality of life following hemicraniectomy for malignant MCA territory infarction. Can J Neurol Sci. 2011;38:434–8.PubMed
29.
Zurück zum Zitat Erban P, Woertgen C, Luerding R, Bogdahn U, Schlachetzki F, Horn M. Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction. Clin Neurol Neurosurg. 2006;108:384–7.PubMedCrossRef Erban P, Woertgen C, Luerding R, Bogdahn U, Schlachetzki F, Horn M. Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction. Clin Neurol Neurosurg. 2006;108:384–7.PubMedCrossRef
30.
Zurück zum Zitat Rahme R, Zuccarello M, Kleindorfer D, Adeoye OM, Ringer AJ. Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living? J Neurosurg. 2012;117:749–54.PubMedCrossRef Rahme R, Zuccarello M, Kleindorfer D, Adeoye OM, Ringer AJ. Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living? J Neurosurg. 2012;117:749–54.PubMedCrossRef
31.
Zurück zum Zitat McKenna A, Wilson CF, Caldwell SB, Curran D. Functional outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions: a systematic review. Br J Neurosurg. 2012;26:310–5.PubMedCrossRef McKenna A, Wilson CF, Caldwell SB, Curran D. Functional outcomes of decompressive hemicraniectomy following malignant middle cerebral artery infarctions: a systematic review. Br J Neurosurg. 2012;26:310–5.PubMedCrossRef
32.
33.
Zurück zum Zitat Rabinstein AA, Hemphill JC. Prognosticating after severe acute brain disease—Science, art, and biases. Neurology. 2010;74:1086–7.PubMedCrossRef Rabinstein AA, Hemphill JC. Prognosticating after severe acute brain disease—Science, art, and biases. Neurology. 2010;74:1086–7.PubMedCrossRef
34.
Zurück zum Zitat Creutzfeldt CJ, Becker KJ, Weinstein JR, et al. Do-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhage. Crit Care Med. 2011;39:158–62.PubMedCentralPubMedCrossRef Creutzfeldt CJ, Becker KJ, Weinstein JR, et al. Do-not-attempt-resuscitation orders and prognostic models for intraparenchymal hemorrhage. Crit Care Med. 2011;39:158–62.PubMedCentralPubMedCrossRef
35.
Zurück zum Zitat Ubel PA, Loewenstein G, Schwarz N, Smith D. Misimagining the unimaginable: the disability paradox and health care decision making. Health Psychol. 2005;24:S57–62.PubMedCrossRef Ubel PA, Loewenstein G, Schwarz N, Smith D. Misimagining the unimaginable: the disability paradox and health care decision making. Health Psychol. 2005;24:S57–62.PubMedCrossRef
36.
Zurück zum Zitat Gilbert DT, Pinel EC, Wilson TD, Blumberg SJ, Wheatley TP. Immune neglect: a source of durability bias in affective forecasting. J Pers Soc Psychol. 1998;75:617–38.PubMedCrossRef Gilbert DT, Pinel EC, Wilson TD, Blumberg SJ, Wheatley TP. Immune neglect: a source of durability bias in affective forecasting. J Pers Soc Psychol. 1998;75:617–38.PubMedCrossRef
Metadaten
Titel
DESTINY-S: Attitudes of Physicians Toward Disability and Treatment in Malignant MCA Infarction
verfasst von
Hermann Neugebauer
Claire J. Creutzfeldt
J. Claude Hemphill III
Peter U. Heuschmann
Eric Jüttler
Publikationsdatum
01.08.2014
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 1/2014
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-014-9956-0

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