title: Factors associated with the withdrawal of life-sustaining therapies in patients with severe traumatic brain injury: a multicenter cohort study.
abstract: OBJECTIVE
  To identify factors associated with decisions to withdraw life-sustaining therapies in patients with severe traumatic brain injury (TBI).
  
  
  METHODS
  We conducted a 2-year multicenter retrospective cohort study (2005-2006) in mechanically ventilated patients aged 16 years and older admitted to the intensive care units (ICUs) of six Canadian level I trauma centers following severe TBI. One hundred and twenty charts were randomly selected at each center (n = 720). Data on ICU management strategies, patients' clinical condition, surgical procedures, diagnostic imaging, and decision to withdraw life-sustaining therapies were collected. The association of factors pertaining to the injury, interventions, and management strategies with decisions to withdraw life-sustaining therapies was evaluated among non-survivors.
  
  
  RESULTS
  Among the 228 non-survivors, 160 died following withdrawal of life-sustaining therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7 (±21.7) years old. Brain herniation was more often reported in patients who died following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91, 95 % confidence interval [CI] 1.16-7.30, p = 0.02) compared to those who died due to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18, 95 % CI 0.06-0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02-0.68, p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02-0.43, p < 0.01) were less often associated with death following withdrawal of life-sustaining therapies than death from other causes.
  
  
  CONCLUSIONS
  Death following decisions to withdraw life-sustaining therapies is associated with specific patient and clinical factors, and the intensity of care.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Côte
authors.forename: Alexis F
authors.initials: AF
authors.lastname: Turgeon
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
authors.forename: Francis
authors.initials: F
authors.lastname: Bernard
authors.forename: Ryan
authors.initials: R
authors.lastname: Zarychanski
authors.forename: Karen E A
authors.initials: KE
authors.lastname: Burns
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.forename: David
authors.initials: D
authors.lastname: Zygun
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Simard
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.forename: Jacques G
authors.initials: JG
authors.lastname: Brochu
authors.forename: Dean A
authors.initials: DA
authors.lastname: Fergusson
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D002170:Canada; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D028761:Withholding Treatment
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents