Abstract Details

Title Do Neuroprognostic Studies in Comatose Cardiac Arrest Survivors Report Factors Contributing to Self-fulfilling Prophecy Bias in Their Methodology? A Systematic Review

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-005

Objective Demonstrate the degree to which the cardiac arrest (CA) neuroprognostic literature accounts for factors related to self-fulfilling prophecy bias (SFPB).

Background SFPB occurs when a perceived prognosis guides treatment decisions, thereby modulating outcomes and potentially inflating prognostic tool performance. We hypothesize that factors influencing how strongly studies are impacted by SFPB are underreported in CA neuroprognostic studies.

Design/Methods We searched MEDLINE, Embase, and Cochrane databases. Two independent reviewers screened and extracted data using Distiller SR® from observational studies and systematic reviews/meta-analyses (from inception-12/31/2022) evaluating the performance of guideline-recommended neuroprognostic tools in survivors of CA with Glasgow Coma Scale<8 or motor subscore<6 aged>17 years. Data were synthesized descriptively; heterogeneity of studies precluded meta-analysis.

Results Of 6161 articles, 221 were included. SFPB was reported in 49% (109/221) of studies with 19% (43/221) also reporting strategies to mitigate this bias. Mortality was reported in 63% (139/221) of studies, of which 44% (61/139) reported timing and 31% (43/139) reported mode of death. Furthermore, withdrawal of life-sustaining therapy (WLST) practices—study-specific, institutional, or cultural—were reported in 46% (64/139) of studies, with 11% (7/64) reporting that cultural or protocol restrictions precluded WLST. The remaining 89% (57/64) of studies mentioned WLST, though WLST rates were provided in only 47% (27/57) with only one study excluding the tool investigated from neuroprognostic impressions informing WLST decisions. Additionally, 56% (15/27) of studies reported perceived poor neurologic prognosis as the most common indication, and in 48% (13/27) WLST occurred within 1 week of CA. Blinding was reported in 55% (122/221) of studies, including blinding of data analysts (35%; 43/122), investigators (45%; 55/122), outcome assessors (25%; 30/122), and treatment team (20%; 25/122).

Conclusions Factors contributing to SFPB are drastically underreported and undermine the reliability of studies informing neuroprognostication tools and guidelines in CA survivors, highlighting an opportunity for increasing transparency and rigor in future studies.

Authors/Disclosures
Hector David Meza Comparan, MD (University of Florida) PRESENTER	Dr. Meza Comparan has nothing to disclose.
Anum Khaliq, MD	Dr. Khaliq has nothing to disclose.
Daniela Pomar Forero, MD (University of Florida)	Ms. Pomar Forero has nothing to disclose.
Viktoriya Gibatova	Ms. Gibatova has nothing to disclose.
Victoria Pollini	Mrs. Pollini has nothing to disclose.
Bakhtawar Ahmad, MBBS	Dr. Ahmad has nothing to disclose.
Samantha Fernandez-Hernandez, MD	Dr. Fernandez-Hernandez has nothing to disclose.
Luciola Martins Frota, MD	Dr. Martins Frota has nothing to disclose.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to AAN interests or activities.
Carolina B. Maciel, MD, MSCR, FAAN	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.

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