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Highlights from this issue
  1. D J C Wilkinson, Associate Editor

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When is death preferable to continued existence? This question all too often faces people, such as me, who work in intensive care. We have the technical ability to sustain organ function for long periods of time—sometimes, it seems, almost indefinitely. However, in the face of severe illness, particularly severe irremediable brain injury, doctors and family members sometimes wonder whether that is the right thing to do.

Several articles in this issue engage with this difficult question. Neurosurgeon Stephen Honeybul and colleagues (Editor's choice, see page 707) provide a thought-provoking insight into the practical dilemmas facing those working in neurosurgical intensive care. They ask whether it is possible to identify a subgroup of adult patients after head injury whose prognosis is sufficiently poor that they should not be treated. The authors apply an outcome prediction model to 5 years of data from patients with head injury in Perth. Patients in the highest risk category had a 58% chance of survival with surgery. However, 88% of survivors were either severely disabled or in a persistent vegetative state. Providing treatment for this group had substantial resource implications, with an average hospital length of stay of 120 days, and …

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