Life Support May End Too Soon After Brain Injury

Large variations in mortality rates from severe traumatic brain injury appear to be partly due to how centers treat withdrawal of life support, researchers found.

Mortality rates for these cases at Canadian trauma centers ranged from just 10.8% to as high as 44.2%, Alexis F. Turgeon, MD, MSc, of Laval University in Quebec, and colleagues reported online in CMAJ.

More than 20% of the variation was estimated to be based on the hospital alone, as it was affected by, and associated with, the rates and timing of withdrawal of life-sustaining therapy in the analysis.

"Communication with families needs to begin early, occur frequently, and deliver a consistent message to achieve optimal outcomes and timing of any withdrawal of support," an accompanying commentary added.
But commentators David H. Livingston, MD, Anne C. Mosenthal, MD, both of New Jersey Medical School in Newark, noted that these results point to physician practice and the culture of medical centers as playing perhaps just as strong a role as patient and family preferences.

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