The final decision among the injured elderly, to stop or to continue? : predictors of withdrawal of life supporting treatment

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BHOGADI, Sai Krishna | MAGNOTTI, Louis J. | HOSSEINPOUR, Hamidreza | ANAND, Tanya | EL-QAWAQZEH, Khaled | NELSON, Adam | COLOSIMO, Christina | SPENCER, Audrey L. | FRIESE, Randall | JOSEPH, Bellal

BACKGROUND: There is a paucity of data on factors that influence the decision regarding withdrawal of life supporting treatment (WLST) in geriatric trauma patients. We aimed to identify predictors of WLST in geriatric trauma patients. METHODS: This retrospective analysis of the ACS-TQIP (2017–2019) included all severely injured (ISS >15) geriatric trauma patients (=65 years). Multivariable logistic regression (MLR) was performed to identify independent predictors of WLST. RESULTS: 155,583 patients were included. Mean age was 77 ± 7 years, 55% were male, 97% sustained blunt injury, and the median ISS was 17 [16-25]. Overall WLST rate was 10.8%. On MLR analysis, increasing age (aOR = 1.35, 95% CI = 1.33 - 1.37; p < 0.001), male sex (aOR = 1.14, 95% CI = 1.09 - 1.18; p < 0.001), white race (aOR = 1.44, 95% CI = 1.36 - 1.52; p < 0.001), frailty (aOR = 1.42, 95% CI = 1.34 - 1.50; p < 0.001), government insurance (aOR = 1.27, 95% CI = 1.20 - 1.33; p < 0.001), presence of advance directive limiting care (ADLC) (aOR = 2.55, 95% CI = 2.40 - 2.70; p < 0.001), severe traumatic brain injury (TBI) (aOR = 1.80, 95% CI = 1.66 - 1.95; p < 0.001), ventilator requirement (aOR = 12.73, 95% CI = 12.09 - 13.39; p < 0.001), and treatment at higher level trauma centers (Level I aOR = 1.49, 95% CI = 1.42 - 1.57; p < 0.001; Level II aOR =1.43, 95% CI = 1.35 - 1.51; p < 0.001) were independently associated with higher odds of WLST. CONCLUSION: Our results suggest that nearly one in ten severely injured geriatric trauma patients undergo WLST. Multiple patient and hospital related factors contribute to decision-making and directed efforts are necessary to create a more standardized process. LEVEL OF EVIDENCE: Epidemiologic, III.

http://dx.doi.org/10.1097/TA.0000000000003924

Voir la revue «The Journal of trauma and acute care surgery»

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