Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients

被引：4

作者：

Sullivan, Michael D. ^{[1
]}

Owattanapanich, Natthida ^{[1
]}

Schellenberg, Morgan ^{[1
]}

Matsushima, Kazuhide ^{[1
]}

Lewis, Meghan R. ^{[1
]}

Lam, Lydia ^{[1
]}

Martin, Matthew ^{[1
]}

Inaba, Kenji ^{[1
]}

机构：

[1] Univ Southern Calif, Keck Sch Med, Los Angeles Gen Med Ctr, Div Trauma & Surg Crit Care, 2051 Marengo St C5L100, Los Angeles, CA 90007 USA

来源：

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2023年 / 54卷 / 12期

关键词：

Withdrawal of life sustaining treatment (WLST); Glasgow coma score (GCS); Associated injury score (AIS); BRAIN-INJURY; THERAPY; CARE; MULTICENTER; DISPARITIES; DEATH; TIME;

D O I：

10.1016/j.injury.2023.111088

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Withdrawal of life sustaining treatment (WLST) occurs when medical intervention no longer benefits a patient's acute goals for care. The incidence of WLST in the trauma patient population is not well understood. The purpose of this study was to examine the incidence and independent risk factors associated with WLST.Methods: The Trauma Quality Improvement Program (2017-2018) was utilized. Patients arrived without signs of life or without mortality or WLST data were excluded. Demographics, injury data, and outcomes were analyzed. Categorical variables are presented as number (percentage) and continuous variables as median [interquartile range]. WLST and non-WLST patients were compared. Early (<24 h) WLST patients were compared to all other WLST patients.Results: Of 749,754 patients, 35,464 (4.7 %) died. Of these, 19,424 (2.6 %) died after WLST, constituting 54.8 % of all deaths. Median age was 67 [50-79], 67.6 % male, 17,557 (90.4 %) blunt injuries, 11,334 (58.4 %) GCS < 9. Median ISS 26 [17-30]. Median head AIS 4 (3-5). The WLST group had a much higher incidence of elderly (60+) patients (65.1% vs 41.0 %), blunt mechanism of injury (90.4% vs 76.9 %) and hypertension (43.5% vs 26.5 %). Black patients (8.2% vs 19.5 %) and Hispanic patients (7.9% vs 12.2 %) were less likely to undergo WLST. On multivariate analysis, patients 80+ years old (OR 12.939, p < 0.001), GCS < 9 (OR 15.621, p < 0.001), and head AIS = 5, head AIS = 6 (OR 3.886, p < 0.001 and OR 5.283, p < 0.001) were independently associated with WLST. GCS < 9 (OR 4.006, p < 0.001) and penetrating injury (OR 2.825, p < 0.001) were independently associated with early WLST within 24 h.Conclusions: More than half who die from trauma undergo withdrawal of life sustaining treatment. Elderly patients and those with severe TBI and low GCS scores are at high risk of experiencing withdrawal of life sustaining treatment. Further prospective evaluation is warranted.

引用

页数：6

共 32 条

[1] Factors Affecting Neurosurgeons' Decisions to Forgo Life-Sustaining Treatments After Traumatic Brain Injury [J].