Neuroworsening: a concept in need of updating

Resumen

Abstract

Assessment and follow up of patients with acute brain pathologies has traditionally been based on the identification of neuroworsening. Today, the central criteria for its detection include the value in the Glasgow Scale and evaluation of pupillary response, which are elements that are modified once the brain injury has progressed enough to alter the clinical status of the patient. This means that both clinical changes are detected late, delaying the response of the medical team. Currently, diverse noninvasive monitoring systems provide parameters and thresholds that could be integrated into a new concept of neuroworsening. This approach would incorporate new criteria for an earlier identification of worsening in patients with acute stage brain injury.  These new techniques and a set of criteria that could form part of a redefinition of neuroworsening are proposed. It is fundamental that this new definition be validated through clinical studies or expert consensus in order to deliver criteria that permit the minimization of the harmful effects of neuroworsening in the prognosis of patients with traumatic brain injury and other neurocritical conditions.