Traumatic Brain Injury Deaths Tied to Life Support Removal

Majority of deaths linked to life-support withdrawal, with variation between medical centers

THURSDAY, Sept. 1 (HealthDay News) -- For patients with traumatic brain injury, most deaths are associated with withdrawal of life-sustaining therapy, according to a study published online Aug. 29 in CMAJ, the journal of the Canadian Medical Association.

Alexis F. Turgeon, M.D., from the Traumatologie-Urgence-Soins Intensifs in Quebec, and colleagues investigated the variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in 720 patients with critical illness and severe traumatic brain injury at six Canadian level-one trauma centers. The effect of the center on hospital mortality and withdrawal of life-sustaining therapy was assessed after adjusting for gender, age, pupillary reactivity, and score on the Glasgow coma scale.

The investigators found a 31.7 percent overall hospital mortality among the patients, ranging between 10.8 and 44.2 percent across the centers. Withdrawal of life-sustaining therapy was associated with most deaths (70.2 percent), ranging between 45 to 86.8 percent. The effect of the center on hospital mortality had an adjusted odds ratio (OR) ranging from 0.61 to 1.55, with the incidence of withdrawal of life-sustaining therapy varying according to center (OR, from 0.42 to 2.40). Nearly one-half of deaths that occurred after the withdrawal of life-sustaining therapies occurred within the first three days of care.

"The high proportion of deaths in all centers following withdrawal of life-sustaining therapy, specifically in the early phase of care, is concerning when placed in the context of limited ability to accurately determine prognosis for patients with severe traumatic brain injury," the authors write.

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