Description of Clinicians' Predictive Abilities Before and After a Diffusion Tensor Imaging (DTI)

With a mortality rate of over 13% in the neuro-intensive care unit, 86% of which are related to the withdrawal of active treatment, predicting a reliable neurological prognosis is of paramount importance in neuro-intensive care to help clinicians inform family members appropriately and tailor care to the patient's presumed wishes. This also helps justify aggressive resuscitation in patients with a presumed good prognosis and, conversely, avoid keeping patients with a poor neurological prognosis alive against their presumed wishes. Current guidelines recommend multimodal neuro-prognostication, in which the clinician synthesizes prognostic data from the clinical examination, EEG, plasma or CSF biomarkers, and imaging to collaboratively develop an individualized prognosis, even though no study has evaluated the quality of this multimodal prognosis. Furthermore, existing variations depending on the nosological context make this approach complex and likely difficult to replicate. Brain MRI is an important tool for neuroprognostics in patients with neurological injuries, and for this reason it is commonly used in clinical practice as part of this multimodal approach. More specifically, brain MRI with diffusion tensor sequences is a validated prognostic tool in post-anoxic coma and traumatic brain injury, as well as, more recently, in subarachnoid hemorrhage, strokes, and hypoglycemia. However, it has not yet been compared to multimodal neuroprognostics performed by the clinician. The primary objective is to compare the prognostic performance of two prescribing clinicians with diffusion tensor MRI before and after the MRI scan is performed. Primary outcome measure: to compare the prognostic performance regarding unfavorable outcomes (Glasgow Outcome Scale Extended \< 5) at 12 months between the two prescribing clinicians and diffusion tensor MRI before and after the MRI scan is performed. A secondary objective will be, among other things, to study the informational g