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 journalArticlepeer-review

37 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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