TY  - JOUR
PY  - 2020//
TI  - Risk factors for withdrawal of life-sustaining treatment in severe traumatic brain injury
JO  - American surgeon
A1  - Gambhir, Sahil
A1  - Grigorian, Areg
A1  - Ramakrishnan, Divya
A1  - Kuza, Catherine M.
A1  - Sheehan, Brian
A1  - Maithel, Shelley
A1  - Nahmias, Jeff
SP  - 8
EP  - 14
VL  - 86
IS  - 1
N2  - 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 <i>versus</i> 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, <i>P</i> < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55-0.65, <i>P</i> < 0.001). Compared with non-survivors of WLST, survivors were older (74 <i>vs</i> 61 years, <i>P</i> < 0.001) and more likely to have comorbidities such as hypertension (57% <i>vs</i> 38.5%, <i>P</i> < 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0003-1348
UR  - http://dx.doi.org/
ID  - ref1
ER  -