Neuroprognostication, or the prediction of recovery from disorders of consciousness caused by severe brain injury, is as critical as it is complex. With profound implications for mortality and quality of life, neuroprognostication draws upon an intricate set of biomedical, probabilistic, psychosocial and ethical factors. However, the clinical approach to neuroprognostication is often unsystematic, and consequently, variable among clinicians and prone to error. Here, we offer a stepwise conceptual framework for reasoning through neuroprognostic determinations — including an evaluation of neurological function, estimation of a recovery trajectory, definition of goals of care and consideration of patient values — culminating in a clinically actionable formula for weighing the risks and benefits of life-sustaining treatment. Although the complexity of neuroprognostication might never be fully reducible to arithmetic, this systematic approach provides structure and guidance to supplement clinical judgement and direct future investigation.

神经预后，或从严重脑损伤引起的意识障碍中恢复的预测，既复杂又重要。神经预测对死亡率和生活质量有着深远的影响，它利用了一系列错综复杂的生物医学、概率、心理社会和伦理因素。然而，神经预后的临床方法通常是不系统的，因此临床医生之间存在差异并且容易出错。在这里，我们提供了一个逐步的概念框架，用于通过神经预后确定进行推理——包括对神经功能的评估、恢复轨迹的估计、护理目标的定义和对患者价值的考虑——最终形成一个临床上可行的公式来权衡风险和收益的维持生命的治疗。