Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury

Abstract

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.

Predictors for Withdrawal of Life-Sustaining Therapies in Patients With Traumatic Brain Injury: A Retrospective Trauma Quality Improvement Program Database Study

“…[8][9][10] Few studies have investigated WLST trends in severe TBI. A study performed by Gambhir et al 11 identified patient-related and injury-related WLST factors, including age and race. However, noninjury factors for WLST in severe TBI have not been well characterized.…”

The Characteristics of Withdrawal or Withholding of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Single Japanese Institutional Study

“…This finding is consistent with previous reports in Europe and America. 2 , 4 , 5 , 6 , 7 , 8 , 10 , 11 , 12 …”

“…Older age was shown to be an independent factor related to the choice of WLST in American, Canadian, French, and Dutch studies on severe TBI. 4 , 5 , 6 , 7 , 8 Previous reports have found that patients with WLST have a higher frequency of acute subdural hematoma (ASDH) than those without WLST in severe TBI settings. 6 However, there is little evidence on the factors influencing the decision to withdraw or continue LSTs in the setting of severe TBI in Japanese institutions.…”

Effect of Ulinastatin Combined with Xingnaojing Injection on Severe Traumatic Craniocerebral Injury and Its Influence on Oxidative Stress Response and Inflammatory Response

“…Meanwhile, it can also prevent the generation of oxygen free radicals, improve the microcirculation in patients, and reduce the damage of tissues and organs under inflammatory and ischemic conditions so as to increase the tolerance of the liver to hypoxia [ 18 – 20 ]. Currently, ulinastatin has been widely used in the treatment of severe traumatic craniocerebral injury and severe pancreatitis for its good therapeutic effect and high safety [ 21 , 22 ]. Xingnaojing is made from Angong Niuhuang Pills which has the effects of cooling blood and detoxicating, clearing away heat and toxic material and eliminating phlegm for resuscitation.…”