ImportanceAmong the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute brain injury. Across a range of brain injury etiologies, these determinations often dictate whether life-sustaining treatment is continued or withdrawn; thus, they have major implications for morbidity, mortality, and health care costs. Neuroprognostication relies on a diverse array of tests, including behavioral, radiologic, physiological, and serologic markers, that evaluate the brain’s functional and structural integrity.ObservationsPrognostic markers, such as the neurologic examination, electroencephalography, and conventional computed tomography and magnetic resonance imaging (MRI), have been foundational in assessing a patient’s current level of consciousness and capacity for recovery. Emerging techniques, such as functional MRI, diffusion MRI, and advanced forms of electroencephalography, provide new ways of evaluating the brain, leading to evolving schemes for characterizing neurologic function and novel methods for predicting recovery.Conclusions and RelevanceNeuroprognostic markers are rapidly evolving as new ways of assessing the brain’s structural and functional integrity after brain injury are discovered. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. However, even as such efforts are underway, a series of promising findings coupled with the imperfect predictive value of conventional prognostic markers and the high stakes of these assessments have prompted clinical guidelines to endorse emerging techniques for neuroprognostication. Thus, clinicians have been thrust into an uncertain predicament in which emerging techniques are not yet perfected but too promising to ignore. This review illustrates the current, and likely future, landscapes of prognostic markers. No matter how much prognostic markers evolve and improve, these assessments must be approached with humility and individualized to reflect each patient’s values.

中文翻译：

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急性脑损伤后昏迷的预测

重要性最具影响力的神经系统评估是神经预测，此处定义为预测严重急性脑损伤引起的意识障碍的神经系统恢复。在一系列脑损伤病因中，这些决定通常决定是否继续或撤回维持生命的治疗；因此，它们对发病率、死亡率和医疗保健费用具有重大影响。神经预测依赖于各种测试，包括行为、放射学、生理和血清学标记，以评估大脑的功能和结构完整性。观察预后标记，例如神经系统检查、脑电图、传统计算机断层扫描和磁共振成像 (MRI) ），是评估患者当前意识水平和恢复能力的基础。功能性 MRI、扩散 MRI 和先进形式的脑电图等新兴技术提供了评估大脑的新方法，从而产生了表征神经功能的方案和预测恢复的新方法。 结论和相关性神经预后标记物正在作为新方法迅速发展发现脑损伤后评估大脑结构和功能完整性的方法。其中许多技术仍在开发中，需要进一步研究来优化其预后效用。然而，即使这些努力正在进行中，一系列有希望的发现，加上传统预后标志物的不完美预测价值以及这些评估的高风险，促使临床指南认可新兴的神经预测技术。因此，临床医生陷入了一个不确定的困境，新兴技术尚未完善，但前景光明，不容忽视。这篇综述阐述了预后标志物当前和未来可能的情况。无论预后标志物发展和改进多少，这些评估都必须以谦逊的态度进行，并进行个性化，以反映每个患者的价值观。