Withdrawal of life-sustaining therapy in injured patients: Variations between trauma centers and nontrauma centers

Zara Cooper, Frederick P. Rivara, Jin Wang, Ellen J. MacKenzie, Gregory Jurkovich

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: We sought to identify patient and institutional variables predictive of a withdrawal of care order (WOCO) in trauma patients. We hypothesized that the frequency of WOCO would be higher at trauma centers. . Methods: Data from the National Study on the Costs and Outcomes of Trauma were used to determine associations between WOCO status and patient characteristics, institutional characteristics, and hospital course. X2; t tests, and multivariate analysis were used to identify variables predictive of WOCO. Results: Of 14,190 patients, 618 (4.4%) had WOCO, which accounted for 60.9% of patients who died in hospital. Age (p = < 0.001), race (p = < 0.001), comorbidity (p = < 0.001), and injury mechanism were associated with WOCO (p = 0.03). WOCO patients had higher New Injury Severity Score (p = <0.001), lower Glasgow Coma Scale motor scores (p = < 0.001), and higher incidence of midline shift on head computed tomography (p = 0.01). Trauma center status (odds ratio, 1.56; 95% confidence interval, 1.06-2.30) and closed intensive care units (odds ratio, 1.53; 95% confidence interval, 1.03-2.25) were also predictive of a WOCO. There was a sizable variation (0%-16%) in the percentage of patients with WOCO across centers. Conclusions: Most trauma patients who die in hospital do so after a WOCO. Although trauma center status and closed intensive care units are predictive of a WOCO, variation in the percentage of patients with WOCO across all centers speaks to the complexity of these decisions. Further investigation is needed to understand how a WOCO is applied to trauma patients.

Original languageEnglish (US)
Pages (from-to)1327-1335
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

Fingerprint

Trauma Centers
Wounds and Injuries
Therapeutics
Intensive Care Units
Odds Ratio
Confidence Intervals
Glasgow Coma Scale
Injury Severity Score
Comorbidity
Patient Care
Multivariate Analysis
Head
Tomography
Costs and Cost Analysis
Incidence

Keywords

  • Elderly trauma
  • End-of-life care
  • Trauma centers
  • Withdrawal of care

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Withdrawal of life-sustaining therapy in injured patients : Variations between trauma centers and nontrauma centers. / Cooper, Zara; Rivara, Frederick P.; Wang, Jin; MacKenzie, Ellen J.; Jurkovich, Gregory.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. 5, 01.05.2009, p. 1327-1335.

Research output: Contribution to journalArticle

@article{6ce6892647594cdcbc973d001420d421,
title = "Withdrawal of life-sustaining therapy in injured patients: Variations between trauma centers and nontrauma centers",
abstract = "Background: We sought to identify patient and institutional variables predictive of a withdrawal of care order (WOCO) in trauma patients. We hypothesized that the frequency of WOCO would be higher at trauma centers. . Methods: Data from the National Study on the Costs and Outcomes of Trauma were used to determine associations between WOCO status and patient characteristics, institutional characteristics, and hospital course. X2; t tests, and multivariate analysis were used to identify variables predictive of WOCO. Results: Of 14,190 patients, 618 (4.4{\%}) had WOCO, which accounted for 60.9{\%} of patients who died in hospital. Age (p = < 0.001), race (p = < 0.001), comorbidity (p = < 0.001), and injury mechanism were associated with WOCO (p = 0.03). WOCO patients had higher New Injury Severity Score (p = <0.001), lower Glasgow Coma Scale motor scores (p = < 0.001), and higher incidence of midline shift on head computed tomography (p = 0.01). Trauma center status (odds ratio, 1.56; 95{\%} confidence interval, 1.06-2.30) and closed intensive care units (odds ratio, 1.53; 95{\%} confidence interval, 1.03-2.25) were also predictive of a WOCO. There was a sizable variation (0{\%}-16{\%}) in the percentage of patients with WOCO across centers. Conclusions: Most trauma patients who die in hospital do so after a WOCO. Although trauma center status and closed intensive care units are predictive of a WOCO, variation in the percentage of patients with WOCO across all centers speaks to the complexity of these decisions. Further investigation is needed to understand how a WOCO is applied to trauma patients.",
keywords = "Elderly trauma, End-of-life care, Trauma centers, Withdrawal of care",
author = "Zara Cooper and Rivara, {Frederick P.} and Jin Wang and MacKenzie, {Ellen J.} and Gregory Jurkovich",
year = "2009",
month = "5",
day = "1",
doi = "10.1097/TA.0b013e31819ea047",
language = "English (US)",
volume = "66",
pages = "1327--1335",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Withdrawal of life-sustaining therapy in injured patients

T2 - Variations between trauma centers and nontrauma centers

AU - Cooper, Zara

AU - Rivara, Frederick P.

AU - Wang, Jin

AU - MacKenzie, Ellen J.

AU - Jurkovich, Gregory

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Background: We sought to identify patient and institutional variables predictive of a withdrawal of care order (WOCO) in trauma patients. We hypothesized that the frequency of WOCO would be higher at trauma centers. . Methods: Data from the National Study on the Costs and Outcomes of Trauma were used to determine associations between WOCO status and patient characteristics, institutional characteristics, and hospital course. X2; t tests, and multivariate analysis were used to identify variables predictive of WOCO. Results: Of 14,190 patients, 618 (4.4%) had WOCO, which accounted for 60.9% of patients who died in hospital. Age (p = < 0.001), race (p = < 0.001), comorbidity (p = < 0.001), and injury mechanism were associated with WOCO (p = 0.03). WOCO patients had higher New Injury Severity Score (p = <0.001), lower Glasgow Coma Scale motor scores (p = < 0.001), and higher incidence of midline shift on head computed tomography (p = 0.01). Trauma center status (odds ratio, 1.56; 95% confidence interval, 1.06-2.30) and closed intensive care units (odds ratio, 1.53; 95% confidence interval, 1.03-2.25) were also predictive of a WOCO. There was a sizable variation (0%-16%) in the percentage of patients with WOCO across centers. Conclusions: Most trauma patients who die in hospital do so after a WOCO. Although trauma center status and closed intensive care units are predictive of a WOCO, variation in the percentage of patients with WOCO across all centers speaks to the complexity of these decisions. Further investigation is needed to understand how a WOCO is applied to trauma patients.

AB - Background: We sought to identify patient and institutional variables predictive of a withdrawal of care order (WOCO) in trauma patients. We hypothesized that the frequency of WOCO would be higher at trauma centers. . Methods: Data from the National Study on the Costs and Outcomes of Trauma were used to determine associations between WOCO status and patient characteristics, institutional characteristics, and hospital course. X2; t tests, and multivariate analysis were used to identify variables predictive of WOCO. Results: Of 14,190 patients, 618 (4.4%) had WOCO, which accounted for 60.9% of patients who died in hospital. Age (p = < 0.001), race (p = < 0.001), comorbidity (p = < 0.001), and injury mechanism were associated with WOCO (p = 0.03). WOCO patients had higher New Injury Severity Score (p = <0.001), lower Glasgow Coma Scale motor scores (p = < 0.001), and higher incidence of midline shift on head computed tomography (p = 0.01). Trauma center status (odds ratio, 1.56; 95% confidence interval, 1.06-2.30) and closed intensive care units (odds ratio, 1.53; 95% confidence interval, 1.03-2.25) were also predictive of a WOCO. There was a sizable variation (0%-16%) in the percentage of patients with WOCO across centers. Conclusions: Most trauma patients who die in hospital do so after a WOCO. Although trauma center status and closed intensive care units are predictive of a WOCO, variation in the percentage of patients with WOCO across all centers speaks to the complexity of these decisions. Further investigation is needed to understand how a WOCO is applied to trauma patients.

KW - Elderly trauma

KW - End-of-life care

KW - Trauma centers

KW - Withdrawal of care

UR - http://www.scopus.com/inward/record.url?scp=67649669892&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649669892&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31819ea047

DO - 10.1097/TA.0b013e31819ea047

M3 - Article

C2 - 19430235

AN - SCOPUS:67649669892

VL - 66

SP - 1327

EP - 1335

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -