Citation

Leonard JM, Polites SF, Martin ND, Glasgow AE, Habermann EB, Kaplan LJ. Injury 2019; 50(5): 1064-1067.

Affiliation

Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Philadelphia, PA, United States; Corporal Michael J. Crescenz VA Medical Center, Surgical Services, Section of Surgical Critical Care, Philadelphia, PA, United States. Electronic address: Lewis.Kaplan@uphs.upenn.edu.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.injury.2019.01.024

PMID

30745124

Abstract

INTRODUCTION: Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources.

METHODS: Trauma Quality Improvement Program (2013-2014) patients who underwent WLST were identified. WLST patients were compared to those who died with full supportive care (FSC). Patients were excluded for death within 24 h of admission, or head AIS > 3. Intergroup comparisons were by student's t tests or Wilcoxon rank sum tests; significance for p < 0.05.

RESULTS: We identified 3471 total injured patients without major TBI who died > 24 h after admission. Of these death after WLST occurred in 2301 (66% of total). This group had a mean age of 66.8 years; 35.7% were women, and 95.4% sustained blunt injury. WLST patients had a higher ISS (21.6 vs. 12.5, p = 0.001), more in-hospital complications (71.4% vs. 41.6%, p = < 0.0001), and a longer ICU length of stay (8.9 days vs. 7.5 days, p = <0.0001) compared to patients who died with FSC.

CONCLUSION: WLST occurs in two-thirds of injured patients without severe TBI who die in the hospital. In-hospital complications are more frequent in this patient group than those who die with FSC. Early palliative care consultation may improve patient and family satisfaction after acute injury when the timeframe to leverage such services is significantly condensed.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Comfort care; Hospice; ICU mortality; Injury; Palliative care; Trauma