@article{ref1,
title="End-of-life decision-making for patients with geriatric trauma cared for in a trauma intensive care unit",
journal="American journal of hospice and palliative medicine",
year="2018",
author="Wooster, Meghan and Stassi, Alyssa and Hill, Joshua and Kurtz, James and Bonta, Marco and Spalding, M. Chance",
volume="35",
number="8",
pages="1063-1068",
abstract="BACKGROUND: The geriatric trauma population is growing and fraught with poor physiological response to injury and high mortality rates. Our primary hypothesis analyzed how prehospital and in-hospital characteristics affect decision-making regarding continued life support (CLS) versus withdrawal of care (WOC). Our secondary hypothesis analyzed adherence to end-of-life decisions regarding code status, living wills, and advanced directives. <br><br>MATERIALS AND METHODS: We performed a retrospective review of patients with geriatric trauma at a level I and level II trauma center from January 1, 2007, to December 31, 2014. Two hundred seventy-four patients met inclusion criteria with 144 patients undergoing CLS and 130 WOC. <br><br>RESULTS: A total of 13 269 patients with geriatric trauma were analyzed. Insurance type and injury severity score (ISS) were found to be significant predictors of WOC ( P =.013/.045). Withdrawal of care patients had shorter time to palliative consultation and those with geriatrics consultation were 16.1 times more likely to undergo CLS ( P =.026). Twenty-seven (33%) patients who underwent CLS and 31 (24%) patients who underwent WOC had a living will, advanced directive, or DNR order ( P =.93). <br><br>CONCLUSIONS: Of the many hypothesized predictors of WOC, ISS was the only tangible independent predictor of WOC. We observed an apparent disconnect between the patient's wishes via living wills or advanced directives &quot;in a terminal condition&quot; and fulfillment during EOL decision-making that speaks to the complex nature of EOL decisions and further supports the need for a multidisciplinary approach.<p /> <p>Language: en</p>",
language="en",
issn="1049-9091",
doi="10.1177/1049909117752670",
url="http://dx.doi.org/10.1177/1049909117752670"
}