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Citation
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Bozkurt I, Umana GE, Deora H, Wellington J, Karakoç E, Chaurasia B. World Neurosurg. 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Traumatic brain injury (TBI) is a multifaceted condition that causes mortality and disability worldwide. There are limited data on factors associated with the decision for withdrawal of life-sustaining treatment (WLST) in patients with TBI. This study aimed to determine risk factors and attitudes affecting neurosurgeons when deciding for WLST in patients with TBI, by applying a multi-center survey.
METHODS: An online questionnaire was applied worldwide and shared using social media platforms and e-mails to approximately 5,000 neurosurgeons. The social media group Neurosurgery Cocktail was used to post a link to the questionnaire while randomly chosen neurosurgery clinics around the world were e-mailed.
RESULTS: 17.22% of participants practiced WLST after TBI in more than 26 cases. Neurosurgeons that performed more WLST were older, had more clinical experience and ICU training, and were better prepared to involve family members of TBI patients in their decision-making when compared to those with lower WLST decisions. The respondents stated that family, ICU consultant, and they themselves played the most influential role in WLST decisions, while the hospital administration, social workers, spiritual caregivers, and nurses had lesser roles. Current and presenting Glasgow Coma Scale scores, pupillary response, advanced age, being a candidate for vegetative state, and impaired neurological function were significant factors associated with WLST decision.
CONCLUSION: This is the first study evaluating neurosurgeons concerning their opinions and behaviors regarding WLST decisions following TBI. Increased age, GCS, pupillary response, the presence of co-morbidities, candidacy for vegetative state, and impaired neurological function were the main factors contributing to decision-making. We also found that the family, ICU consultants and the attending neurosurgeon played the most effective roles in WLST decisions.
Language: en |