Neurology- Support Withdrawal Causes Deaths After Traumatic Brain Injury
According to a study in the Canadian Medical Association Journal, most deaths of patients with traumatic brain injury result from withdrawal of life support within the first 3 days of ICU admission. This study published on August 29th highlighted “the need for high-quality research to better inform decisions to stop life-sustaining treatments for these patients”.
Dr. Alexis F. Turgeon and his associates wrote: “In some instances this may be too early for accurate neuroprognostication.” The study showed that “the most common reasons given for withdrawing life-sustaining therapy were the medical team’s opinion that chance of survival was poor (54% of cases), the next of kin’s opinion that the prognosis was incompatible with the patient’s wishes (34%), and the medical team’s opinion that long-term neurologic prognosis was poor (29%).”
The study in six trauma centres showed that the rate of withdrawal varies greatly from one hospital to another. It would appear that the difference in withdrawal rates may be influenced by physician practice and the culture of medical centres. For example, the rate of withdrawal among the centres ranged from 45%-87%. According to an article in Internal Medicine News reporting on the study, “More than 70% of the patient deaths stemmed directly from withdrawal of life-sustaining therapy, including 64% of patients who died within three days of admission to an ICU.”
Early withdrawal of life-sustaining therapy after a traumatic brain injury raises concerns about the hastening of death and “increasing mortality for patients who might otherwise recover with more time.”
To read the study online visit: http://www.cmaj.ca/content/early/2011/08/29/cmaj.101786