Withdrawal of life-supporting treatment in severe traumatic brain injury.

IF 3.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of neurosurgery Pub Date : 2025-09-12 DOI:10.3171/2025.4.JNS243077

Astrid C Hengartner, Paul Serrato, Shaila D Ghanekar, Michael DiLuna, Aladine A Elsamadicy

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引用次数: 0

Abstract

Objective: Factors that influence the decision for withdrawal of life-supporting treatment (WLST) in patients with severe traumatic brain injury (sTBI) are incompletely understood.

Methods: The authors conducted a retrospective cohort study using the 2016-2022 American College of Surgeons Trauma Quality Programs database to identify demographic and clinical factors associated with the decision for WLST in patients with sTBI. Multivariable logistic regression analysis was conducted. Hospital length of stay (LOS), intensive care unit LOS, number of days on a ventilator, and disposition outcomes were compared between patients with and without WLST.

Results: A total of 202,160 patients with sTBI were identified, of whom 44,341 (21.9%) had WLST. The risk of WLST increased with age, with patients > 75 years of age (adjusted odds ratio [aOR] 5.82, 95% CI 5.51-6.14; p < 0.001) being at the highest risk of having WLST. Black (aOR 0.59, 95% CI 0.57-0.62; p < 0.001) and Hispanic (aOR 0.76, 95% CI 0.73-0.80; p < 0.001) patients had lower odds of WLST. Patients with Medicare had significantly higher odds of having WLST (aOR 1.39, 95% CI 1.33-1.45; p < 0.001) compared to patients with private insurance. The risk of WLST decreased with increasing Glasgow Coma Scale (GCS) scores; patients with a GCS score of 7 or 8 were the least likely to have WLST (aOR 0.65, 95% CI 0.62-0.67; p < 0.001). Patients with one (aOR 1.89, 95% CI 1.80-1.99; p < 0.001) or two (aOR 2.46, 95% CI 2.38-2.53; p < 0.001) nonreactive pupils were more likely to have WLST. Patients with no midline shift (aOR 0.58, 95% CI 0.56-0.59; p < 0.001) were less likely to have WLST. Patients with penetrating injuries (aOR 1.43, 95% CI 1.33-1.53; p < 0.001) had significantly higher odds of WLST compared to those with blunt injuries. On average, patients with WLST had a considerably shorter hospital LOS (6.2 ± 8.4 days vs 16.6 ± 20.3 days) compared with no-WLST patients.

Conclusions: WLST in sTBI patients is associated with various features, including patient age, race, and insurance status. Further exploration is needed to fully understand the factors that impact the decision for WLST, with the aim of improving patient outcomes and care across socioeconomic divides.

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重型颅脑外伤患者生命支持治疗的退出。

目的：影响严重创伤性脑损伤（sTBI）患者退出生命支持治疗（WLST）决策的因素尚不完全清楚。方法：作者使用2016-2022年美国外科医师学会创伤质量项目数据库进行了一项回顾性队列研究，以确定与sTBI患者决定WLST相关的人口统计学和临床因素。进行多变量logistic回归分析。比较了有和没有WLST患者的住院时间（LOS）、重症监护病房LOS、呼吸机天数和处置结果。结果：共发现202160例sTBI患者，其中44341例（21.9%）为WLST。WLST的风险随着年龄的增长而增加，年龄在0 - 75岁之间的患者发生WLST的风险最高（校正优势比[aOR] 5.82, 95% CI 5.51-6.14; p < 0.001）。黑人（aOR 0.59, 95% CI 0.57-0.62; p < 0.001）和西班牙裔（aOR 0.76, 95% CI 0.73-0.80; p < 0.001）患者发生WLST的几率较低。与私人保险患者相比，医疗保险患者发生WLST的几率显著更高（aOR 1.39, 95% CI 1.33-1.45; p < 0.001）。随着格拉斯哥昏迷评分（GCS）的增加，WLST的风险降低；GCS评分为7或8分的患者发生WLST的可能性最小（aOR 0.65, 95% CI 0.62-0.67; p < 0.001）。一个（aOR 1.89, 95% CI 1.80-1.99; p < 0.001）或两个（aOR 2.46, 95% CI 2.38-2.53; p < 0.001）无反应瞳孔的患者更容易发生WLST。没有中线移位的患者（aOR 0.58, 95% CI 0.56-0.59; p < 0.001）发生WLST的可能性较小。穿透性损伤患者（aOR 1.43, 95% CI 1.33-1.53; p < 0.001）发生WLST的几率明显高于钝性损伤患者。平均而言，与无WLST患者相比，WLST患者的住院LOS（6.2±8.4天vs 16.6±20.3天）明显缩短。结论：sTBI患者的WLST与多种特征相关，包括患者年龄、种族和保险状况。为了改善不同社会经济阶层患者的预后和护理，需要进一步探索以充分了解影响WLST决策的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.