Dr. Susanne Muehlschlegel is a Critical Care Neurologist at the University of Massachusetts Medical School (UMMS) whose goal is to become an independent investigator with expertise in patient outcome prediction, shared decision making, and decision-science to improve clinical decision making for patients with catastrophic brain injuries and their families. Moderate to severe traumatic brain injury (msTBI) remains the leading cause of death after trauma which mostly follows withdrawal of care. Dr. Muehlschlegel will tackle the life-or-death decision about continuation or withdrawal of care (goals-of-care) in msTBI patients and develop a decision aid for health care proxies of these critically ill patients. Dr. Muehlschlegel's career development plan brings together an outstanding team of investigators from three leading institutions, including the UMMS, University of New England, and University of Pittsburgh. Dr. Muehlschlegel has already obtained preliminary results in msTBI patients confirming that intensive care unit (ICU) complications are associated with worse short-term functional patient outcomes and mortality, and also lead to worse subjective prognostication by clinicians. Based on her daily interactions with families of msTBI patients in her unique clinical position as a neuroICU physician, Dr. Muehlschlegel is acutely aware of the need to improve prognostication and its communication between physicians and families while also including patient's values and preferences. Under the mentorship of Drs. Goldberg, Col, Shutter and Mazor, Dr. Muehlschlegel proposes to: (1a) identify key psychosocial factors of goals-of-care decisions in health care proxies of msTBI patients and physicians in focus groups and structured interviews; (1b) develop a new outcome prediction score for msTBI patients including ICU complications and previously validated admission predictors in a prospectively collected hospital-based cohort of patients with msTBI and to validate her findings internally; (2) create a decision aid prototype for goals-of- care decisions in msTBI patients by incorporating results from Aims 1a and 1b, and the well known and validated msTBI outcome prediction IMPACT score based on hospital admission variables; and (3) to pilot test the decision aid in a feasibility trial in the neuroICU. The overal goal of this proposal is to develop a goals- of-care decision aid that may improve health outcomes for msTBI patients by ensuring proxies receive evidence-based prognostication, understand projected outcomes and risks, while also addressing patient's preferences and values. This well-defined mentored patient-oriented research proposal will bring together cutting-edge qualitative and quantitative methods for decision aid and outcome prediction rule derivation, and a team with expertise in outcomes research, shared decision making, and neurocritical care of msTBI patients. This proposal, in concert with a structured didactic curriculum of advanced statistical, qualitative, and decision- science coursework, will provide Dr. Muehlschlegel with the skills and mentorship that are essential for her to develop an independent career in neuroICU research at the cutting edge of shared decision making science.

Public Health Relevance

Shared decision making, a priority of Healthy People 2020 and the Institute of Medicine, has the potential to improve outcomes for critically ill patients wih traumatic brain injury by ensuring health care proxies receive evidence-based prognostication, understand projected outcomes and risks, while also addressing patients' preferences and values. Despite modern advances in prevention and treatment, traumatic brain injury remains the leading cause of death after trauma in the U.S. Dr. Muehlschlegel's proposed career development plan has an outstanding potential to improve the clinical decision making in critically ill traumatic brain injury patients and advance our knowledge of long-term outcome determinants of these high risk patients, a crucial next step toward the limitation of biased outcome prognostication, discovery of modifiable risk factors, and development of effective strategies for treatment of intensive care unit complications after traumatic brain injury.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HD080971-03
Application #
9304870
Study Section
National Institute of Child Health and Human Development Initial Review Group (CHHD)
Program Officer
Marden, Susan F
Project Start
2015-07-26
Project End
2020-06-30
Budget Start
2017-07-01
Budget End
2018-06-30
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Neurology
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
Khan, Muhammad Waqas; Muehlschlegel, Susanne (2018) Shared Decision Making in Neurocritical Care. Neurosurg Clin N Am 29:315-321
Humble, Stephen S; Wilson, Laura D; Wang, Li et al. (2018) Prognosis of diffuse axonal injury with traumatic brain injury. J Trauma Acute Care Surg 85:155-159
Moskowitz, Jesse; Quinn, Thomas; Khan, Muhammad W et al. (2018) Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians' Perceptions. MDM Policy Pract 3:2381468318757987
Henninger, Nils; Compton, Rebecca A; Khan, Muhammad W et al. (2018) ""Don't lose hope early"": Hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients. J Trauma Acute Care Surg 84:473-482
Khan, Muhammad Waqas; Muehlschlegel, Susanne (2017) Shared Decision Making in Neurocritical Care. Neurol Clin 35:825-834
Cheng, Katarina; Bassil, Ribal; Carandang, Raphael et al. (2017) The Estimated Verbal GCS Subscore in Intubated Traumatic Brain Injury Patients: Is it Really Better? J Neurotrauma 34:1603-1609
Quinn, Thomas; Moskowitz, Jesse; Khan, Muhammad W et al. (2017) What Families Need and Physicians Deliver: Contrasting Communication Preferences Between Surrogate Decision-Makers and Physicians During Outcome Prognostication in Critically Ill TBI Patients. Neurocrit Care 27:154-162
Marehbian, Jonathan; Muehlschlegel, Susanne; Edlow, Brian L et al. (2017) Medical Management of the Severe Traumatic Brain Injury Patient. Neurocrit Care 27:430-446
Ahlawat, Aditi; Carandang, Raphael; Heard, Stephen O et al. (2016) The Modified Apnea Test During Brain Death Determination: An Alternative in Patients With Hypoxia. J Intensive Care Med 31:66-9
Muehlschlegel, Susanne; Ayturk, Didem; Ahlawat, Aditi et al. (2016) Predicting survival after acute civilian penetrating brain injuries: The SPIN score. Neurology 87:2244-2253

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