Skip to main content
Top

Open Access 16-01-2024 | Central Nervous System Trauma | Original Article

Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers

Authors: Menco J. S. Niemeyer, Denise Jochems, Jan C. Van Ditshuizen, Janneke de Kanter, Lotte Cremers, Martijn van Hattem, Dennis Den Hartog, Roderick Marijn Houwert, Luke P. H. Leenen, Karlijn J. P. van Wessem

Published in: European Journal of Trauma and Emergency Surgery

Login to get access

Abstract

Purpose

With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers.

Methods

From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18 years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3–6 months post-discharge were collected.

Results

The study population included 596 patients (UMC-R: n = 326; UMC-U: n = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4–5] vs. UMC-U: 4 [4–5], p < 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (n = 170), of which 71% (n = 123) occurred after WLST. Two percent (n = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up.

Discussion

This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care.

Level of evidence

Level III, retrospective cohort study.
Appendix
Available only for authorised users
Literature
7.
go back to reference Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMed
8.
go back to reference Gunning AC, Niemeyer MJS, Van Heijl M, et al. Inter-rater reliability of the Abbreviated Injury Scale scores in patients with severe head injury shows good interrater agreement but variability between countries. Eur J Trauma Acute Care Surg. 2022;49:1183. Gunning AC, Niemeyer MJS, Van Heijl M, et al. Inter-rater reliability of the Abbreviated Injury Scale scores in patients with severe head injury shows good interrater agreement but variability between countries. Eur J Trauma Acute Care Surg. 2022;49:1183.
11.
go back to reference Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of Support in Intracerebral Hemorrhage May Lead to Self-Fulfilling Prophecies. Neurology. 2001;56:766.CrossRefPubMed Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of Support in Intracerebral Hemorrhage May Lead to Self-Fulfilling Prophecies. Neurology. 2001;56:766.CrossRefPubMed
22.
go back to reference Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
30.
go back to reference Gambhir S, Grigorian A, Ramakrishnan D, et al. Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury. Am Surg. 2020;86(1):8–14.CrossRefPubMed Gambhir S, Grigorian A, Ramakrishnan D, et al. Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury. Am Surg. 2020;86(1):8–14.CrossRefPubMed
39.
go back to reference van Erp W, Lavrijsen J, Koopmans RTCM. The unresponsive wakefulness syndrome: Dutch perspectives. Ned Tijdschr Geneeskd. 2016;160(D108):27484418. van Erp W, Lavrijsen J, Koopmans RTCM. The unresponsive wakefulness syndrome: Dutch perspectives. Ned Tijdschr Geneeskd. 2016;160(D108):27484418.
40.
go back to reference Souter MJ, Blissitt PA, Blosser S, et al. Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management: A Position Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2015;23(1):4–13. https://doi.org/10.1007/s12028-015-0137-6.CrossRefPubMed Souter MJ, Blissitt PA, Blosser S, et al. Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management: A Position Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2015;23(1):4–13. https://​doi.​org/​10.​1007/​s12028-015-0137-6.CrossRefPubMed
Metadata
Title
Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury: a retrospective comparison of two Dutch level-I trauma centers
Authors
Menco J. S. Niemeyer
Denise Jochems
Jan C. Van Ditshuizen
Janneke de Kanter
Lotte Cremers
Martijn van Hattem
Dennis Den Hartog
Roderick Marijn Houwert
Luke P. H. Leenen
Karlijn J. P. van Wessem
Publication date
16-01-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02407-5