title: In-hospital end-of-life decisions after new traumatic spinal cord injury in the Netherlands.
abstract: METHODS
  Explorative retrospective files study.
  
  
  OBJECTIVE
  To document end-of-life decisions (ELDs) in in-hospital deaths after new traumatic spinal cord injury (TSCI).
  
  
  METHODS
  The Netherlands.
  
  
  METHODS
  Discharge letters concerning patients with TSCI discharged from Dutch acute hospitals in 2010 were analysed. Data were extracted on survival, personal and lesion characteristics, comorbidities, other injuries, preexisting spinal stenosis, stabilising surgery, length of hospital stay and the presence and types of ELDs. Characteristics of deceased patients and survivors were compared using χ2and T-tests. Characteristics of the deceased patients and ELDs were further explored.
  
  
  RESULTS
  A total of 185 patients with new TSCI were identified. Twenty-six patients were excluded as their survival status at discharge was unknown-for example, because of discharge to another hospital without information about their final discharge. Thirty of the remaining 159 patients died during their initial hospital stay (18.9%). Deceased patients were older and had more often high cervical and motor complete injuries than survivors. The circumstances of death were sparsely documented, and in nine cases, it was not possible to determine the absence or the presence of an ELD. ELDs were reported in 19 deaths (63.3%). All were non-treatment decisions, and almost all (89.5%) were decisions of withdrawal of treatment. There were no cases of documented euthanasia or physician-assisted suicide.
  
  
  CONCLUSIONS
  ELDs were reported in the majority of in-hospital deaths after new TSCI in the Netherlands (63.3%), and all were non-treatment decisions.
authors.affiliation: Jeroen Bosch Hospital, Tolbrug Rehabilitation Centre, Groningen, The Netherlands.|University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Osterthun
authors.affiliation: De Hoogstraat Rehabilitation, Utrecht, The Netherlands.|Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: F W A
authors.initials: FW
authors.lastname: van Asbeck
authors.affiliation: Rijndam Rehabilitation, Rotterdam, The Netherlands.
authors.forename: J H B
authors.initials: JH
authors.lastname: Nijendijk
authors.affiliation: University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.|Brain Center Rudolf Magnus and Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: M W M
authors.initials: MW
authors.lastname: Post
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000401:mortality* / Q000523:psychology*; D016019:Survival Analysis; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill; D055815:Young Adult