The Characteristics of Withdrawal or Withholding of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Single Japanese Institutional Study

Shinsuke Tanizaki; Yasuo Toma; Katsuyoshi Miyashita; Shigenobu Maeda

doi:10.1016/j.wnsx.2022.100144

The Characteristics of Withdrawal or Withholding of Life-Sustaining Treatment in Severe Traumatic Brain Injury: A Single Japanese Institutional Study

World Neurosurg X. 2022 Oct 4:17:100144. doi: 10.1016/j.wnsx.2022.100144. eCollection 2023 Jan.

Authors

Shinsuke Tanizaki¹, Yasuo Toma², Katsuyoshi Miyashita², Shigenobu Maeda¹

Affiliations

¹ Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
² Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan.

Abstract

Objectives: There is little evidence on the factors influencing the decision to withdraw or continue life-sustaining treatment in the setting of severe traumatic brain injury in Japanese institutions. We investigated the factors associated with the withdrawal or withholding of life-sustaining treatment (WLST) for severe traumatic brain injury at a single Japanese institution.

Methods: A total of 161 patients with severe traumatic brain injury were retrospectively reviewed. Patient characteristics and injury types were compared between patients with and without the WLST.

Results: Of the 161 patients, 87 (54%) died and 52 (32%) decided to undergo WLST. In 98% of the WLST cases, the decision was made within 24 h of admission. The mean duration between WLST and death was 2 days. The predicted probabilities for mortality and unfavorable outcomes were highest in patients with WLST within 24 h. Patients with WLST were older and had a higher frequency of falls on the ground, ischemic heart disease, and acute subdural hemorrhage than those without WLST.

Conclusions: The decisions of almost all WLST cases were made within 24 h of admission for severe traumatic brain injury in a Japanese institution because of Japanese patients' religious and cultural backgrounds.

Keywords: AIS, Abbreviated Injury Scale; ASDH, Acute subdural hemorrhage; Confucianism; GCS, Glasgow Coma Scale; IMPACT, International Mission for Prognosis and Analysis of Clinical Trials in TBI; LST, Life-sustaining treatment; Severe traumatic brain injury; TBI, Traumatic brain injury; WLST, Withdrawal or withholding of life-sustaining treatments; Withdrawal or withholding of life-sustaining treatment.