Factors impacting mortality and withdrawal of life sustaining therapy in severe traumatic brain injury.

Abstract

Objective: To evaluate the correlation between withdrawal of life-sustaining therapy (WLST) and established prognostic indicators, as well as identify additional factors that may influence the timing of WLST.

Methods: This retrospective case-control study examined adult patients admitted between 8/1/18 and 7/31/21 with severe TBI. A case group of 164 individuals who underwent WLST after TBI was matched 1:1 to a control group of 164 individuals with TBI who did not undergo WLST. Clinical indicators of poor prognosis were recorded, and functional recovery of control subjects was evaluated using Glasgow Outcome Scale Extended (GOSE).

Results: The study involved 328 individuals (66 ± 19.9 years). Significant findings revealed lower GCS scores and shorter hospital stays in the case group compared to controls. Bilaterally absent pupillary responses were more common in cases (54.8%) and associated with shorter time to WLST and poorer functional outcomes in controls. Palliative care consultations and DNR code status were associated with time to WLST and functional outcomes. Non-geriatric control patients had better functional outcomes at follow-up (GOSE 6.3 ± 1.7) than geriatric patients (3.1 ± 1.5).

Conclusions: These findings emphasize the importance of standardized guidelines, objective indicators, and avoiding nihilism in making WLST decisions as many control subjects achieved functional recovery at varying levels of independence.