Neurocritical Care

, Volume 18, Issue 1, pp 154–160

Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study

  • Nicolas Côte
  • Alexis F. Turgeon
  • François Lauzier
  • Lynne Moore
  • Damon C. Scales
  • Francis Bernard
  • Ryan Zarychanski
  • Karen E. A. Burns
  • Maureen O. Meade
  • David Zygun
  • Jean-François Simard
  • Amélie Boutin
  • Jacques G. Brochu
  • Dean A. Fergusson
Ethical Matters

DOI: 10.1007/s12028-012-9787-9

Cite this article as:
Côte, N., Turgeon, A.F., Lauzier, F. et al. Neurocrit Care (2013) 18: 154. doi:10.1007/s12028-012-9787-9

Abstract

Purpose

To identify factors associated with decisions to withdraw life-sustaining therapies in patients with severe traumatic brain injury (TBI).

Materials and Methods

We conducted a 2-year multicenter retrospective cohort study (2005–2006) in mechanically ventilated patients aged 16 years and older admitted to the intensive care units (ICUs) of six Canadian level I trauma centers following severe TBI. One hundred and twenty charts were randomly selected at each center (n = 720). Data on ICU management strategies, patients’ clinical condition, surgical procedures, diagnostic imaging, and decision to withdraw life-sustaining therapies were collected. The association of factors pertaining to the injury, interventions, and management strategies with decisions to withdraw life-sustaining therapies was evaluated among non-survivors.

Results

Among the 228 non-survivors, 160 died following withdrawal of life-sustaining therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7 (±21.7) years old. Brain herniation was more often reported in patients who died following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91, 95 % confidence interval [CI] 1.16–7.30, p = 0.02) compared to those who died due to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18, 95 % CI 0.06–0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02–0.68, p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02–0.43, p < 0.01) were less often associated with death following withdrawal of life-sustaining therapies than death from other causes.

Conclusions

Death following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.

Keywords

Withdrawal of life-sustaining therapy Mortality Traumatic brain injury Risk factors End-of-life 

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Nicolas Côte
    • 1
  • Alexis F. Turgeon
    • 1
    • 2
  • François Lauzier
    • 1
    • 2
    • 3
  • Lynne Moore
    • 2
    • 4
  • Damon C. Scales
    • 5
  • Francis Bernard
    • 6
  • Ryan Zarychanski
    • 7
  • Karen E. A. Burns
    • 8
  • Maureen O. Meade
    • 9
  • David Zygun
    • 10
  • Jean-François Simard
    • 2
  • Amélie Boutin
    • 2
  • Jacques G. Brochu
    • 1
  • Dean A. Fergusson
    • 11
  1. 1.Division of Critical Care Medicine, Department of AnesthesiologyUniversité LavalQuebecCanada
  2. 2.Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l’Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit)Université LavalQuebecCanada
  3. 3.Department of MedicineUniversité LavalQuebecCanada
  4. 4.Department of Social and Preventive MedicineUniversité LavalQuebecCanada
  5. 5.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  6. 6.Department of Internal MedicineUniversité de MontréalMontrealCanada
  7. 7.Department of Internal Medicine, Section of Critical Care MedicineUniversity of ManitobaWinnipegCanada
  8. 8.Department of Critical Care Medicine, St-Michael’s HospitalUniversity of TorontoTorontoCanada
  9. 9.Department of Critical Care MedicineMcMaster UniversityHamiltonCanada
  10. 10.Department of Critical Care MedicineUniversity of CalgaryCalgaryCanada
  11. 11.Clinical Epidemiology Unit, Ottawa Hospital Research InstituteUniversity of OttawaOttawaCanada

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