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Abstract
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BACKGROUND: Each year, traumatic injury accounts for large number of patient admissions and deaths in the US. Injuries have tremendous public health implications, and controlling and treating traumatised patients is an essential part of any health delivery system. Nonetheless, traumatised patients whose terminal hospitalisation ends in the intensive care unit (ICU) are a particular demographic group that has not been well studied.
Methods: Here, we review demographic trends, critical care unit utilisation and outcomes for trauma patients. Based on the available data, we discuss issues related to specific patient groups (such as the elderly), management of end-of-life patients in the ICU, views of medical professionals relative to end-of-life care and costs associated and with care of terminally ill patients. In this context, we also review and discuss recent data on withdrawal of life-sustaining therapies for trauma patients.
Conclusions: We conclude that it is difficult for physicians, patients and their families to recognise when care should focus on comfort rather than aggressive interventions that prolong dying. This is particularly difficult in situations of trauma, where unexpected injury causes profound disability. Nonetheless, the challenges pertain to trauma patients as they do to all critically ill patients, where providing an ethical and dignified death can be as heroic as aggressive measures to save life. More studies are needed to determine how we can best meet the needs of terminally ill trauma patients and their families.
Keywords Trauma, end-of-life, withdrawal of treatment
Language: en |