Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study
| Autor: | Jean-François Simard, Alexis F. Turgeon, Tran Cong Dung, David A. Zygun, Lynne Moore, Maureen O. Meade, François Lauzier, Mohana Ratnapalan, Damon C. Scales, Francis Bernard, Dean Fergusson, Stephanie Todd, John Harlock, Karen E. A. Burns |
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| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty business.industry Traumatic brain injury Research Glasgow Coma Scale Poison control Retrospective cohort study General Medicine Odds ratio medicine.disease Life Support Care Brain Injuries Injury prevention medicine Humans Female Hospital Mortality Young adult Intensive care medicine business Cohort study |
| Popis: | Background: Severe traumatic brain injury often leads to death from withdrawal of life-sustaining therapy, although prognosis is difficult to determine. Methods: To evaluate variation in mortality following the withdrawal of life-sustaining therapy and hospital mortality in patients with critical illness and severe traumatic brain injury, we conducted a two-year multicentre retrospective cohort study in six Canadian level-one trauma centres. The effect of centre on hospital mortality and withdrawal of life-sustaining therapy was evaluated using multivariable logistic regression adjusted for baseline patient-level covariates (sex, age, pupillary reactivity and score on the Glasgow coma scale). Results: We randomly selected 720 patients with traumatic brain injury for our study. The overall hospital mortality among these patients was 228/720 (31.7%, 95% confidence interval [CI] 28.4%–35.2%) and ranged from 10.8% to 44.2% across centres (χ 2 test for overall difference, p 2 test for overall difference, p p p = 0.001). About one half of deaths that occurred following the withdrawal of life-sustaining therapies happened within the first three days of care. Interpretation: We observed significant variation in mortality across centres. This may be explained in part by regional variations in physician, family or community approaches to the withdrawal of life-sustaining therapy. Considering the high proportion of early deaths associated with the withdrawal of life-sustaining therapy and the limited accuracy of current prognostic indicators, caution should be used regarding early withdrawal of life-sustaining therapy following severe traumatic brain injury. |
| Databáze: | OpenAIRE |
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