Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study

Côte, N; Turgeon, Alexis F.; Lauzier, François; Moore, Lynne; Scales, Damon C.; Bernard, Francis; Zarychanski, Ryan; Burns, Karen E. A.; Meade, Maureen O.; Zygun, David; Simard, J. Marc; Boutin, Amélie; Brochu, Jacques G.; Fergusson, Dean

doi:10.1007/s12028-012-9787-9

Cited by 51 publications

(34 citation statements)

References 27 publications

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“…This has been described as the "self-fulfilling prophesy" in which the patient for whom poor outcomes are seen as inevitable may be treated as though their condition can only worsen and prematurely have withdrawal of care. 13,15,16 To avoid this, health care providers need reliable predictive models, in addition to their own clinical judgment, to predict mortality and functional outcome on a consistent basis.…”

Section: Discussionmentioning

confidence: 99%

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Bonds

Dhanda

Wade

et al. 2021

Journal of Neurotrauma

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Accurate prognostication of outcomes following traumatic brain injury (TBI) affects not only the aggressiveness of intervention and therapeutic decision-making, but also the clinicians' ability to provide reliable expectations. To investigate the relative ability of clinicians to accurately predict a patient's outcomes when compared to point of care prognostic models, we surveyed clinical providers of 86 patients with moderate-severe TBI at admission, day 3, and day 7 post-injury for a patient's predicted functional outcome at six months and mortality. The predicted mortality and functional outcomes were compared to actual occurrence of 14 day mortality and functional outcomes at six months. A prognostic score was then calculated utilizing the Corticoid Randomization After Signiﬁcant Head Injury (CRASH) and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models and categorized as high, intermediate, and low likelihood of mortality or poor functional outcome and compared to clinical predictions. Overall, clinicians of varying backgrounds showed an accurate prediction of survival (87.2-97.4%) but struggled in prognosticating poor functional outcomes (24.3-36.6%). These values did not statistically improve over 7 days. Stratified CRASH (87.2%) and IMPACT (84.9%) accuracy rates were statistically better than clinical judgment alone in predicting functional outcomes (p<0.0001). Prognostic models calculated at admission showed to be potentially useful in conjunction with clinical judgment in accurately predicting both survival and six month functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Bonds

Dhanda

Wade

et al. 2021

Journal of Neurotrauma

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“…Significant variations in mortality across centers (median 31.7%, range 10.8–44.2%) and variations in physicians’ prognostic thinking and approaches to withdrawal of life-sustaining treatment were found in connected studies [21, 22, 33]. …”

Section: Discussionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundTreatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting.MethodsA retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs.ResultsTLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1–652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients’ preferences were found in only 7% of cases.DiscussionClinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.ConclusionTLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

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“…We conducted a post hoc analysis of a large multicentre retrospective cohort study of critically ill patients with severe TBI. 16,17 The multicentre cohort study was conducted in six level I trauma centres from three Canadian provinces (Québec, Ontario, Alberta) over a 24-month period (n = 720) (16,17). Patients were identified at all centres using the International Statistical Classification of Diseases and Related Health Problems, tenth revision (codes for traumatic brain injury: S06.0-S06.9).…”

Section: Methodsmentioning

confidence: 99%

Intensity of care and withdrawal of life-sustaining therapies in severe traumatic brain injury patients: a post-hoc analysis of a multicentre retrospective cohort study

Gerges

Moore

Léger

et al. 2018

Can J Anesth/J Can Anesth

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Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study

Abstract: Death following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.

Cited by 51 publications

References 27 publications

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Intensity of care and withdrawal of life-sustaining therapies in severe traumatic brain injury patients: a post-hoc analysis of a multicentre retrospective cohort study

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