The analysis of 1,392 patients with traumatic brain injuries (TBIs) revealed that some patients who had life support withdrawn might have survived and regained some level of independence a few months after the injury. Typically, families are required to decide whether to withdraw life support within 72 hours of a brain injury, but the new study suggests that delaying such decisions could be beneficial for some patients. Severe traumatic brain injury (TBI) is a leading cause of hospitalizations and deaths globally, affecting over five million people annually. Predicting outcomes following a brain injury can be difficult.Families are often faced with the difficult task of deciding whether to continue or stop life-sustaining treatment shortly after a loved one experiences a traumatic brain injury. A recent study by Mass General Brigham researchers looked at the potential outcomes for TBI patients enrolled in the TRACK-TBI study who had life support withdrawn. The study found that some patients who had life support withdrawn could have potentially survived and regained some level of independence a few months after the injury. These findings indicate that delaying the decision to withdraw life support could be beneficial for some patients.Patients.
Families are often asked to make decisions about discontinuing life support, such as mechanical breathing, within 72 hours of a brain injury. Doctors often provide information suggesting a poor prognosis for brain function, and this is the most common reason families choose to discontinue life support. However, there are currently no specific medical guidelines or algorithms to determine which patients with severe TBI are likely to recover.
By analyzing data from 1,392 TBI patients in intensive care units at 18 trauma centers in the United States over a 7.5-year period, the researchers developed a mathematical model to predict the likelihood of recovery.The study looked at the likelihood of withdrawing life-sustaining treatment based on factors such as demographics, socioeconomic status, and injury characteristics. They then compared individuals who had life-sustaining treatment withdrawn (WLST+) with individuals who had similar characteristics but did not have treatment withdrawn (WLST-).
The follow-up showed that a significant number of the WLST+ group either died or regained some independence in daily activities within six months. Among the survivors, over 40 percent of the WLST- group regained some level of independence.The research team discovered that it was unlikely for patients to remain in a vegetative state six months after their injury. It is important to note that none of the patients in the study were declared brain dead, so the results do not apply to brain death cases.
The authors believe that there is a self-fulfilling prophecy happening, where clinicians expect patients to have poor outcomes based on data, leading to the withdrawal of life support. This in turn increases the rate of poor outcomes and results in more decisions to withdraw life support.
The authors recommend conducting further studies to better understand this phenomenon.Research that includes larger sample sizes is necessary to better understand the recovery trajectories of patients who experience traumatic brain injuries. This will allow for more precise matching of WLST+ and WLST- cohorts. Corresponding author Yelena Bodien, PhD, of the Department of Neurology’s Center for Neurotechnology and Neurorecovery at Massachusetts General Hospital and of the Spaulding-Harvard Traumatic Brain Injury Model Systems, emphasized the importance of a cautious approach to early decisions regarding withdrawal of life support. She also highlighted the need for long-term follow-ups to understand patient outcomes, as traumatic brain injury is a chronic condition.The study, published on May 13 in the Journal of Neurotrauma, explores the potential for recovery in patients who have had life-sustaining treatment withdrawn. The research suggests that delaying decisions about life support may help to identify patients whose condition could improve.
