title: Withdrawal of care in a trauma intensive care unit: the impact on mortality rate.
abstract: Withdrawal of care has increased in recent years as the population older than 65 years of age has increased. We sought to investigate the impact of this decision on our mortality rate. We retrospectively reviewed a prospectively collected database to determine the percentage of cases in which care was actively withdrawn. Neurologic injury as the cause for withdrawal, age of the patient, number of days to death, number of cases thought to be treatment failures, and the reason for failure were analyzed. Between January 2008 and December 2012, there were 536 trauma service deaths; 158 (29.5%) had care withdrawn. These patients were 67 (± 18.5) years old and neurologic injury was responsible in 63 per cent (± 5.29%). Fifty-two per cent of the patients died by Day 3; 65 per cent by Day 5; and 74 per cent Day 7. A total of 22.7 per cent (± 7.9%) could be considered a treatment failure. Accounting for cases in which care was withdrawn for futility would decrease the overall mortality rate by approximately 23 per cent. Trauma center mortality calculation does not account for care withdrawn. Treating an active, aging population, with advance directives, requires methodologies that account for such decision-making when determining mortality rates.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Weireter
authors.forename: Jay N
authors.initials: JN
authors.lastname: Collins
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Britt
authors.forename: T J
authors.initials: TJ
authors.lastname: Novosel
authors.forename: L D
authors.initials: LD
authors.lastname: Britt
mesh_terms: D000367:Age Factors; D000368:Aged; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014768:Virginia / Q000453:epidemiology; D028761:Withholding Treatment; D014947:Wounds and Injuries / Q000401:mortality*