End -of -life practices in traumatic brain injury patients: Report of a questionnaire from the CENTER-TBI study

Purpose: We aimed to study variation regarding speci fic end -of -life (EoL) practices in the intensive care unit (ICU) in traumatic brain injury (TBI) patients. Materials and methods: Respondents from 67 hospitals participating in The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study completed several questionnaires on man- agement of TBI patients. Results: In 60% of the centers, ?50% of all patients with severe neurological damage dying in the ICU, die after withdrawal of life -sustaining measures (LSM). The decision to withhold/withdraw LSM was made following multidisciplinary consensus in every center. Legal representatives/relatives played a role in the decision - making process in 81% of the centers. In 82% of the centers, age played a role in the decision to withhold/with- draw LSM. Furthermore, palliative therapy was initiated in 79% of the centers after the decision to withdraw LSM was made. Last, withholding/withdrawing LSM was, generally, more often considered after more time had passed, in a patient with TBI, who remained in a very poor prognostic condition. Conclusion: We found variation regarding EoL practices in TBI patients. These results provide insight into variabil- ity regarding important issues pertaining to EoL practices in TBI, which can be useful to stimulate discussions on EoL practices, comparative effectiveness research, and, ultimately, development of recommendations. ? 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).