Niemeyer, Menco J. S.;
Jochems, Denise;
Van Ditshuizen, Jan C.;
de Kanter, Janneke;
Cremers, Lotte;
van Hattem, Martijn;
Den Hartog, Dennis;
Houwert, Roderick Marijn;
Leenen, Luke P. H.;
van Wessem, Karlijn J. P.
Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers
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Medientyp:
E-Artikel
Titel:
Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers
Beteiligte:
Niemeyer, Menco J. S.;
Jochems, Denise;
Van Ditshuizen, Jan C.;
de Kanter, Janneke;
Cremers, Lotte;
van Hattem, Martijn;
Den Hartog, Dennis;
Houwert, Roderick Marijn;
Leenen, Luke P. H.;
van Wessem, Karlijn J. P.
Erschienen:
Springer Science and Business Media LLC, 2024
Erschienen in:
European Journal of Trauma and Emergency Surgery (2024)
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Purpose</jats:title>
<jats:p>With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18 years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3–6 months post-discharge were collected.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The study population included 596 patients (UMC-R: <jats:italic>n</jats:italic> = 326; UMC-U: <jats:italic>n</jats:italic> = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4–5] vs. UMC-U: 4 [4–5], <jats:italic>p</jats:italic> < 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (<jats:italic>n</jats:italic> = 170), of which 71% (<jats:italic>n</jats:italic> = 123) occurred after WLST. Two percent (<jats:italic>n</jats:italic> = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up.</jats:p>
</jats:sec><jats:sec>
<jats:title>Discussion</jats:title>
<jats:p>This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care.</jats:p>
</jats:sec><jats:sec>
<jats:title>Level of evidence</jats:title>
<jats:p>Level III, retrospective cohort study.</jats:p>
</jats:sec>