Citation

Tanizaki S, Toma Y, Miyashita K, Maeda S. World Neurosurg. X 2023; 17: e100144.

Copyright

(Copyright © 2023, Elsevier Publishing)

DOI

10.1016/j.wnsx.2022.100144

PMID

36353247

PMCID

PMC9637969

Abstract

OBJECTIVES: There is little evidence on the factors influencing the decision to withdraw or continue life-sustaining treatment in the setting of severe traumatic brain injury in Japanese institutions. We investigated the factors associated with the withdrawal or withholding of life-sustaining treatment (WLST) for severe traumatic brain injury at a single Japanese institution.

METHODS: A total of 161 patients with severe traumatic brain injury were retrospectively reviewed. Patient characteristics and injury types were compared between patients with and without the WLST.

RESULTS: Of the 161 patients, 87 (54%) died and 52 (32%) decided to undergo WLST. In 98% of the WLST cases, the decision was made within 24 h of admission. The mean duration between WLST and death was 2 days. The predicted probabilities for mortality and unfavorable outcomes were highest in patients with WLST within 24 h. Patients with WLST were older and had a higher frequency of falls on the ground, ischemic heart disease, and acute subdural hemorrhage than those without WLST.

CONCLUSIONS: The decisions of almost all WLST cases were made within 24 h of admission for severe traumatic brain injury in a Japanese institution because of Japanese patients' religious and cultural backgrounds.

Language: en

Keywords

Severe traumatic brain injury; AIS, Abbreviated Injury Scale; ASDH, Acute subdural hemorrhage; Confucianism; GCS, Glasgow Coma Scale; IMPACT, International Mission for Prognosis and Analysis of Clinical Trials in TBI; LST, Life-sustaining treatment; TBI, Traumatic brain injury; Withdrawal or withholding of life-sustaining treatment; WLST, Withdrawal or withholding of life-sustaining treatments