Citation

Ball CG, Navsaria PH, Kirkpatrick AW, Vercler C, Dixon E, Zink J, Laupland KB, Lowe M, Salomone JP, Dente CJ, Wyrzykowski AD, Hameed SM, Widder S, Inaba K, Ball JE, Rozycki GS, Montgomery SP, Hayward T, Feliciano DV. J. Trauma 2010; 69(6): 1323-33; discussion 1333-4.

Affiliation

From the Department of Surgery (C.G.B., C.V., J.Z., M.L., J.P.S., C.J.D., A.D.W., J.E.B., G.S.R., D.V.F.), Emory University, Grady Memorial Hospital, Atlanta, Georgia; Department of Surgery (P.N.),University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa; Department of Surgery (A.W.K., E.D.), University of Calgary, Calgary, Alberta, Canada; Department of Surgery (K.B.L), Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Surgery (S.M.H.), University of British Columbia, Vancouver, British Columbia, Canada; Department of Surgery (S.W.) University of Alberta, Edmonton, Alberta, Canada; Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Department of Surgery (S.P.M.), Walter Reed Army Medical Center, Washington, DC; Department of Surgery (T.H.), Wishard Hospital, Indianapolis, Indiana.

Copyright

(Copyright © 2010, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e3181f66878

PMID

21045742

Abstract

BACKGROUND:: Up to 20% of all trauma patients admitted to an intensive care unit die from their injuries. End-of-life decision making is a variable process that involves prognosis, predicted functional outcomes, personal beliefs, institutional resources, societal norms, and clinician experience. The goal of this study was to better understand end-of-life processes after major injury by comparing clinician viewpoints from various countries and cultures. METHODS:: A clinician-based, 38-question international survey was used to characterize the impacts of medical, religious, social, and system factors on end-of-life care after trauma. RESULTS:: A total of 419 clinicians from the United States (49%), Canada (19%), South Africa (11%), Europe (9%), Asia (8%), and Australasia (4%) completed the survey. In America, the admitting surgeon guided most end-of-life decisions (51%), when compared with all other countries (0-27%). The practice structure of American respondents also varied from other regions. Formal medical futility laws are rarely available (14-38%). Ethical consultation services are often accessible (29-98%), but rarely used (0-29%), and typically unhelpful (<30%). End-of-life decision making for patients with traumatic brain injuries varied extensively across regions with regard to the impact of patient age, Glasgow Coma Scale score, and clinician philosophy. Similar differences were observed for spinal cord injuries (age and functional level). The availability and use of "donation after cardiac death" also varied substantially between countries. CONCLUSIONS:: In this unique study, geographic differences in religion, practice composition, decision-maker viewpoint, and institutional resources resulted in significant variation in end-of-life care after injury. These disparities reflect competing concepts (patient autonomy, distributive justice, and religion).

Language: en