J. Leonard1, S. Polites2, A. Glasgow2, N. Martin1, E. Habermann2 1University Of Pennsylvania,Philadelphia, PA, USA 2Mayo Clinic,Rochester, MN, USA
Introduction: Many trauma patients and their families make the difficult decision to withdraw life sustaining support following injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo withdrawal of support (WOS) exclusive of TBI. The objective of this study was to describe this population of patients and help providers identify patients who would benefit from early involvement of palliative care resources.
Methods: Patients were identified from the 2013-2014 Trauma Quality Improvement Program who underwent WOC. WOC patients were compared to those who died without WOS and those who survived to discharge. Patients who died within the first 24 hours or had a head AIS of 3 or greater were excluded.
Results: WOS after 24 hours occurred in 2301 patients. The median age was 71 years, 35.7% were women, and 95.4% had a blunt injury mechanism. Compared with patients who died in-hospital with full supportive measures, WOS patients had a higher ISS (21.6 vs. 12.5, p = 0.001), were more likely to have in hospital complications (71.4% vs. 41.6%, p = < 0.0001), and had a longer ICU length of stay (8.9 days vs. 7.5 days, p = <0.0001).
Conclusion: WOS occurs in many trauma patients without severe TBI, demonstrating the importance of having palliative care options and resources available for these patients. Direction of resources can be optimized using the characteristics of patients who chose WOS identified in this study.
