Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study.
Level 3 - non-randomized controlled study
Multicentre retrospective cohort study
PubMed 21876014 · doi:10.1503/cmaj.101786
What was done
Researchers conducted a two-year retrospective cohort study of 720 randomly selected critically ill patients with severe traumatic brain injury across six Canadian level-one trauma centres. Multivariable logistic regression was used to evaluate the effect of centre on hospital mortality and withdrawal of life-sustaining therapy, adjusting for age, sex, pupillary reactivity, and Glasgow Coma Scale score.
What was found
Overall hospital mortality was 31.7% (228/720, 95% CI 28.4%-35.2%) and varied across centres from 10.8% to 44.2% (p < 0.001; adjusted OR range 0.61 to 1.55). Most deaths (70.2% [160/228], 95% CI 63.9%-75.7%) followed withdrawal of life-sustaining therapy, ranging across centres from 45.0% (18/40) to 86.8% (46/53) (p < 0.001; adjusted OR range 0.42 to 2.40). Approximately half of the deaths following withdrawal of life-sustaining therapy occurred within the first three days.
Why it matters
Mortality following severe traumatic brain injury is largely driven by withdrawal of life-sustaining therapy. Significant unexplained variation across centres suggests that institutional culture and local practice patterns heavily influence end-of-life decisions early in care.
Limits
The study is retrospective and limited to six Canadian level-one trauma centres. Adjustments were restricted to a small set of baseline variables (age, sex, GCS, pupillary reactivity), leaving potential unmeasured clinical or anatomical confounders, and the abstract provides no long-term functional outcome data.