Treatment-limiting decisions in patients with severe traumatic brain injury in the Netherlands

• DOI: 10.1016/j.bas.2024.102746
• Publication Date: 2024-01-04T00:24:39Z
• Authors: Inge A.M. van Erp; T.A. van Essen; Erwin J.O. Kompanje; Mathieu van der Jagt; Wouter A. Moojen; Wilco C. Peul; Jeroen T.J.M. van...
• Keywords: Limiting

Treatment-limiting decisions (TLDs) can be inevitable severe traumatic brain injury (s-TBI) patients, but data on their use remain scarce. To investigate the prevalence, timing and considerations of TLDs in s-TBI patients. patients between 2008 2017 were analysed retrospecively. Patient data, timing, location, involvement proxies, reasons for collected. Baseline characteristics in-hospital outcomes compared with without TLDs. reported 117 270 (43.3%) 95.9% deaths after preceded by a TLD. The majority (68.4%) categorized as withdrawal therapy, which organ-support 64.1%. Neurosurgical intervention was withheld 29.9%. median time from admission to TLD 2 days [IQR, 0–8] 50.4% made within 3 admission. main reason that perceived unsalvageable (66.7%). Nearly all multidisciplinary (99.1%) proxies (75.2%). predicted mortality (CRASH-score) 72.6 vs. 70.6%. percentage increased 20.0% 42.9% 2012 64.3% 2017. occurred almost half instituted more frequently over time. Half spite baseline prognosis groups being similar. Future research should address whether prognostic nihilism contributes self-fulfilling prophecies.