Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients

Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients

•Withdrawal of life sustaining treatment is common, occurring in 54.8 % of trauma patients who die in the hospital.•WLST is associated with severe TBI, advanced age, and pre-existing comorbidities.•GCS 

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Injury 2023-12, Vol.54 (12), p.111088-111088, Article 111088
Hauptverfasser: Sullivan, Michael D., Owattanapanich, Natthida, Schellenberg, Morgan, Matsushima, Kazuhide, Lewis, Meghan R., Lam, Lydia, Martin, Matthew, Inaba, Kenji
Format: Artikel
Sprache:eng
Schlagworte:
Associated injury score (AIS)
Glasgow coma score (GCS)
Withdrawal of life sustaining treatment (WLST)
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 111088
container_issue 12
container_start_page 111088
container_title Injury
container_volume 54
creator Sullivan, Michael D.
Owattanapanich, Natthida
Schellenberg, Morgan
Matsushima, Kazuhide
Lewis, Meghan R.
Lam, Lydia
Martin, Matthew
Inaba, Kenji
description •Withdrawal of life sustaining treatment is common, occurring in 54.8 % of trauma patients who die in the hospital.•WLST is associated with severe TBI, advanced age, and pre-existing comorbidities.•GCS 
doi_str_mv 10.1016/j.injury.2023.111088
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2877379955</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0020138323007921</els_id><sourcerecordid>2877379955</sourcerecordid><originalsourceid>FETCH-LOGICAL-c288t-5af256967c4361b7a1ddc74a9020bfe65133c3370b0a160d5ad7d4510f2a4b253</originalsourceid><addsrcrecordid>eNp9kElPwzAQhS0EEqXwDzj4yCXFSxInFyRUlUWqxAXO1sQLdciG7VD670mVnrnMaEbvjeZ9CN1SsqKE5vf1ynX16A8rRhhfUUpJUZyhBS1EmRCWi3O0IISRhPKCX6KrEGpCqCCcL5DZ_ELrOtd94rgz2HXaDGYqXcTehS9sQcXeB2x7j_cu7rSHPTS4t7hx1uAwhggnuzcQ26PRddMAYwt4gOimTbhGFxaaYG5OfYk-njbv65dk-_b8un7cJooVRUwysCzLy1yolOe0EkC1ViKFcnq-sibPKOeKc0EqAjQnOgMtdJpRYhmkFcv4Et3Ndwfff48mRNm6oEzTQGf6MUhWCMFFWWZHaTpLle9D8MbKwbsW_EFSIo9UZS1nqvJIVc5UJ9vDbDNTjB9nvAxqiqiMdt6oKHXv_j_wB7Xdg_4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2877379955</pqid></control><display><type>article</type><title>Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients</title><source>Elsevier ScienceDirect Journals</source><creator>Sullivan, Michael D. ; Owattanapanich, Natthida ; Schellenberg, Morgan ; Matsushima, Kazuhide ; Lewis, Meghan R. ; Lam, Lydia ; Martin, Matthew ; Inaba, Kenji</creator><creatorcontrib>Sullivan, Michael D. ; Owattanapanich, Natthida ; Schellenberg, Morgan ; Matsushima, Kazuhide ; Lewis, Meghan R. ; Lam, Lydia ; Martin, Matthew ; Inaba, Kenji</creatorcontrib><description><![CDATA[•Withdrawal of life sustaining treatment is common, occurring in 54.8 % of trauma patients who die in the hospital.•WLST is associated with severe TBI, advanced age, and pre-existing comorbidities.•GCS < 9 is the greatest single risk factor for WLST in trauma patients. Withdrawal of life sustaining treatment (WLST) occurs when medical intervention no longer benefits a patient's acute goals for care. The incidence of WLST in the trauma patient population is not well understood. The purpose of this study was to examine the incidence and independent risk factors associated with WLST. The Trauma Quality Improvement Program (2017–2018) was utilized. Patients arrived without signs of life or without mortality or WLST data were excluded. Demographics, injury data, and outcomes were analyzed. Categorical variables are presented as number (percentage) and continuous variables as median [interquartile range]. WLST and non-WLST patients were compared. Early (<24 h) WLST patients were compared to all other WLST patients. Of 749,754 patients, 35,464 (4.7 %) died. Of these, 19,424 (2.6 %) died after WLST, constituting 54.8 % of all deaths. Median age was 67 [50–79], 67.6 % male, 17,557 (90.4 %) blunt injuries, 11,334 (58.4 %) GCS < 9. Median ISS 26 [17–30]. Median head AIS 4 (3–5). The WLST group had a much higher incidence of elderly (60+) patients (65.1% vs 41.0 %), blunt mechanism of injury (90.4% vs 76.9 %) and hypertension (43.5% vs 26.5 %). Black patients (8.2% vs 19.5 %) and Hispanic patients (7.9% vs 12.2 %) were less likely to undergo WLST. On multivariate analysis, patients 80+ years old (OR 12.939, p < 0.001), GCS < 9 (OR 15.621, p < 0.001), and head AIS = 5, head AIS = 6 (OR 3.886, p < 0.001 and OR 5.283, p < 0.001) were independently associated with WLST. GCS < 9 (OR 4.006, p < 0.001) and penetrating injury (OR 2.825, p < 0.001) were independently associated with early WLST within 24 h. More than half who die from trauma undergo withdrawal of life sustaining treatment. Elderly patients and those with severe TBI and low GCS scores are at high risk of experiencing withdrawal of life sustaining treatment. Further prospective evaluation is warranted.]]></description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2023.111088</identifier><language>eng</language><publisher>Elsevier Ltd</publisher><subject>Associated injury score (AIS) ; Glasgow coma score (GCS) ; Withdrawal of life sustaining treatment (WLST)</subject><ispartof>Injury, 2023-12, Vol.54 (12), p.111088-111088, Article 111088</ispartof><rights>2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c288t-5af256967c4361b7a1ddc74a9020bfe65133c3370b0a160d5ad7d4510f2a4b253</cites><orcidid>0000-0002-5191-596X ; 0000-0002-7196-1496</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids></links><search><creatorcontrib>Sullivan, Michael D.</creatorcontrib><creatorcontrib>Owattanapanich, Natthida</creatorcontrib><creatorcontrib>Schellenberg, Morgan</creatorcontrib><creatorcontrib>Matsushima, Kazuhide</creatorcontrib><creatorcontrib>Lewis, Meghan R.</creatorcontrib><creatorcontrib>Lam, Lydia</creatorcontrib><creatorcontrib>Martin, Matthew</creatorcontrib><creatorcontrib>Inaba, Kenji</creatorcontrib><title>Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients</title><title>Injury</title><description><![CDATA[•Withdrawal of life sustaining treatment is common, occurring in 54.8 % of trauma patients who die in the hospital.•WLST is associated with severe TBI, advanced age, and pre-existing comorbidities.•GCS < 9 is the greatest single risk factor for WLST in trauma patients. Withdrawal of life sustaining treatment (WLST) occurs when medical intervention no longer benefits a patient's acute goals for care. The incidence of WLST in the trauma patient population is not well understood. The purpose of this study was to examine the incidence and independent risk factors associated with WLST. The Trauma Quality Improvement Program (2017–2018) was utilized. Patients arrived without signs of life or without mortality or WLST data were excluded. Demographics, injury data, and outcomes were analyzed. Categorical variables are presented as number (percentage) and continuous variables as median [interquartile range]. WLST and non-WLST patients were compared. Early (<24 h) WLST patients were compared to all other WLST patients. Of 749,754 patients, 35,464 (4.7 %) died. Of these, 19,424 (2.6 %) died after WLST, constituting 54.8 % of all deaths. Median age was 67 [50–79], 67.6 % male, 17,557 (90.4 %) blunt injuries, 11,334 (58.4 %) GCS < 9. Median ISS 26 [17–30]. Median head AIS 4 (3–5). The WLST group had a much higher incidence of elderly (60+) patients (65.1% vs 41.0 %), blunt mechanism of injury (90.4% vs 76.9 %) and hypertension (43.5% vs 26.5 %). Black patients (8.2% vs 19.5 %) and Hispanic patients (7.9% vs 12.2 %) were less likely to undergo WLST. On multivariate analysis, patients 80+ years old (OR 12.939, p < 0.001), GCS < 9 (OR 15.621, p < 0.001), and head AIS = 5, head AIS = 6 (OR 3.886, p < 0.001 and OR 5.283, p < 0.001) were independently associated with WLST. GCS < 9 (OR 4.006, p < 0.001) and penetrating injury (OR 2.825, p < 0.001) were independently associated with early WLST within 24 h. More than half who die from trauma undergo withdrawal of life sustaining treatment. Elderly patients and those with severe TBI and low GCS scores are at high risk of experiencing withdrawal of life sustaining treatment. Further prospective evaluation is warranted.]]></description><subject>Associated injury score (AIS)</subject><subject>Glasgow coma score (GCS)</subject><subject>Withdrawal of life sustaining treatment (WLST)</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kElPwzAQhS0EEqXwDzj4yCXFSxInFyRUlUWqxAXO1sQLdciG7VD670mVnrnMaEbvjeZ9CN1SsqKE5vf1ynX16A8rRhhfUUpJUZyhBS1EmRCWi3O0IISRhPKCX6KrEGpCqCCcL5DZ_ELrOtd94rgz2HXaDGYqXcTehS9sQcXeB2x7j_cu7rSHPTS4t7hx1uAwhggnuzcQ26PRddMAYwt4gOimTbhGFxaaYG5OfYk-njbv65dk-_b8un7cJooVRUwysCzLy1yolOe0EkC1ViKFcnq-sibPKOeKc0EqAjQnOgMtdJpRYhmkFcv4Et3Ndwfff48mRNm6oEzTQGf6MUhWCMFFWWZHaTpLle9D8MbKwbsW_EFSIo9UZS1nqvJIVc5UJ9vDbDNTjB9nvAxqiqiMdt6oKHXv_j_wB7Xdg_4</recordid><startdate>202312</startdate><enddate>202312</enddate><creator>Sullivan, Michael D.</creator><creator>Owattanapanich, Natthida</creator><creator>Schellenberg, Morgan</creator><creator>Matsushima, Kazuhide</creator><creator>Lewis, Meghan R.</creator><creator>Lam, Lydia</creator><creator>Martin, Matthew</creator><creator>Inaba, Kenji</creator><general>Elsevier Ltd</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5191-596X</orcidid><orcidid>https://orcid.org/0000-0002-7196-1496</orcidid></search><sort><creationdate>202312</creationdate><title>Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients</title><author>Sullivan, Michael D. ; Owattanapanich, Natthida ; Schellenberg, Morgan ; Matsushima, Kazuhide ; Lewis, Meghan R. ; Lam, Lydia ; Martin, Matthew ; Inaba, Kenji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c288t-5af256967c4361b7a1ddc74a9020bfe65133c3370b0a160d5ad7d4510f2a4b253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Associated injury score (AIS)</topic><topic>Glasgow coma score (GCS)</topic><topic>Withdrawal of life sustaining treatment (WLST)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sullivan, Michael D.</creatorcontrib><creatorcontrib>Owattanapanich, Natthida</creatorcontrib><creatorcontrib>Schellenberg, Morgan</creatorcontrib><creatorcontrib>Matsushima, Kazuhide</creatorcontrib><creatorcontrib>Lewis, Meghan R.</creatorcontrib><creatorcontrib>Lam, Lydia</creatorcontrib><creatorcontrib>Martin, Matthew</creatorcontrib><creatorcontrib>Inaba, Kenji</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sullivan, Michael D.</au><au>Owattanapanich, Natthida</au><au>Schellenberg, Morgan</au><au>Matsushima, Kazuhide</au><au>Lewis, Meghan R.</au><au>Lam, Lydia</au><au>Martin, Matthew</au><au>Inaba, Kenji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients</atitle><jtitle>Injury</jtitle><date>2023-12</date><risdate>2023</risdate><volume>54</volume><issue>12</issue><spage>111088</spage><epage>111088</epage><pages>111088-111088</pages><artnum>111088</artnum><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract><![CDATA[•Withdrawal of life sustaining treatment is common, occurring in 54.8 % of trauma patients who die in the hospital.•WLST is associated with severe TBI, advanced age, and pre-existing comorbidities.•GCS < 9 is the greatest single risk factor for WLST in trauma patients. Withdrawal of life sustaining treatment (WLST) occurs when medical intervention no longer benefits a patient's acute goals for care. The incidence of WLST in the trauma patient population is not well understood. The purpose of this study was to examine the incidence and independent risk factors associated with WLST. The Trauma Quality Improvement Program (2017–2018) was utilized. Patients arrived without signs of life or without mortality or WLST data were excluded. Demographics, injury data, and outcomes were analyzed. Categorical variables are presented as number (percentage) and continuous variables as median [interquartile range]. WLST and non-WLST patients were compared. Early (<24 h) WLST patients were compared to all other WLST patients. Of 749,754 patients, 35,464 (4.7 %) died. Of these, 19,424 (2.6 %) died after WLST, constituting 54.8 % of all deaths. Median age was 67 [50–79], 67.6 % male, 17,557 (90.4 %) blunt injuries, 11,334 (58.4 %) GCS < 9. Median ISS 26 [17–30]. Median head AIS 4 (3–5). The WLST group had a much higher incidence of elderly (60+) patients (65.1% vs 41.0 %), blunt mechanism of injury (90.4% vs 76.9 %) and hypertension (43.5% vs 26.5 %). Black patients (8.2% vs 19.5 %) and Hispanic patients (7.9% vs 12.2 %) were less likely to undergo WLST. On multivariate analysis, patients 80+ years old (OR 12.939, p < 0.001), GCS < 9 (OR 15.621, p < 0.001), and head AIS = 5, head AIS = 6 (OR 3.886, p < 0.001 and OR 5.283, p < 0.001) were independently associated with WLST. GCS < 9 (OR 4.006, p < 0.001) and penetrating injury (OR 2.825, p < 0.001) were independently associated with early WLST within 24 h. More than half who die from trauma undergo withdrawal of life sustaining treatment. Elderly patients and those with severe TBI and low GCS scores are at high risk of experiencing withdrawal of life sustaining treatment. Further prospective evaluation is warranted.]]></abstract><pub>Elsevier Ltd</pub><doi>10.1016/j.injury.2023.111088</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-5191-596X</orcidid><orcidid>https://orcid.org/0000-0002-7196-1496</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 0020-1383
ispartof Injury, 2023-12, Vol.54 (12), p.111088-111088, Article 111088
issn 0020-1383
1879-0267
language eng
recordid cdi_proquest_miscellaneous_2877379955
source Elsevier ScienceDirect Journals
subjects Associated injury score (AIS)
Glasgow coma score (GCS)
Withdrawal of life sustaining treatment (WLST)
title Examining the independent risk factors for withdrawal of life sustaining treatment in trauma patients
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T20%3A06%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Examining%20the%20independent%20risk%20factors%20for%20withdrawal%20of%20life%20sustaining%20treatment%20in%20trauma%20patients&rft.jtitle=Injury&rft.au=Sullivan,%20Michael%20D.&rft.date=2023-12&rft.volume=54&rft.issue=12&rft.spage=111088&rft.epage=111088&rft.pages=111088-111088&rft.artnum=111088&rft.issn=0020-1383&rft.eissn=1879-0267&rft_id=info:doi/10.1016/j.injury.2023.111088&rft_dat=%3Cproquest_cross%3E2877379955%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2877379955&rft_id=info:pmid/&rft_els_id=S0020138323007921&rfr_iscdi=true