Table 3.
Representative quotes for core cycle components
| Edges | Representative quotes | Expert N=17 (%) | General N=19 (%) |
|---|---|---|---|
| Acquire to Interpret | “We are defining (EEG) after ACNS (American Clinical Neurophysiology Society) of highly malignant patterns and benign patterns. So that’s how we scored EEG. We scored the evoke potentials bilaterally absent versus present, we don’t use the amplitude. We score the clinical examination using the FOUR score after the Mayo Clinic. We don’t have a clear threshold, but of course if we repeat the examination, we look at the brainstem reflexes and the evolution of the FOUR score. We have a safe threshold for the NSE in our lab at about 70 microgram per milliliter.” (Expert, Europe) “[I aim] to get an idea if there are particularly ominous signs on the brain MRI like damage to the bilateral thalami or extensive laminar necrosis or other findings that are consistent with severe anoxic brain injury” (General, North America) |
17 (100) | 19 (100) |
| Interpret to Formulate Prognosis | “I am looking for cerebral edema that is below where we have seen survivability. For me, that’s if the gray-white landmarks are gone or if the cortex is really tight with sulcal effacement or the cisterns are obliterated. Then, I feel …this person has a very poor prognosis…”(Expert, North America) “If the patient has recovered, for example, continuous background activity, which may be one of the best ways of assessing a potential good outcome. On the contrary where the patient has developed myoclonus seizures or even myoclonus status, which is a very bad sign in combination with a certain cEEG pattern.” (Expert, Europe) “If EEG is burst-identical burst, or NPI is 2 and we don’t have motor response … we are really pessimistic, and we just don’t feel that patient would be able to be awake.” (General, Europe) “Poor prognosis, which I usually think of as like absent corneal responses, absent pupillary responses.” (General, North America) |
17 (100) | 18 (95) |
| Formulate Prognosis to Acquire | “I described that I am constantly revising my estimated chance of recovery for the patient in my own head. I would constantly seek greater certainty, so if I feel that the test would increase my certainty, I would get it”(Expert, North America) “So in other words, if up to 48 to 72 hours, we are still in the gray zone, the patients don’t awaken and on the other side doesn’t have very poor prognosticators. We try to get to more evidence”(Expert, Europe) “So when in doubt, we prolong the observation period. If you don’t have strong predictors suggesting that prognosis will be very poor, or if you don’t have a series of less robust predictors, all consistently indicating and signaling that the prognosis will be poor, generally we wait” (Expert, Europe) |
17 (100) | 18 (95) |