Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe…

Cohort studyTrauma surgery & acute care open· 2026

Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.

Nicole Russell, Alexander L Eastman, Jennifer L Grant

Emergency Trauma CareCohort studyQ2IF 1.7

Major chest injury predicted delayed withdrawal of life support in brain-injured trauma patients

Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.

Nicole Russell … Jennifer L Grant

Trauma surgery & acute care open · 2026 · Q2 in Critical Care

Background

Trauma-specific palliative care guidelines are limited, and physicians rely heavily on experience to guide goals-of-care discussions, leading to substantial practice variation.

Methods

Were stratified by the presence of moderate to severe traumatic brain injury.

n = 990 patients

Results

major chest injury raised the odds of delayed withdrawal

OR 1.30 (95% CI 1.10 to 1.40)

null 1

1.10

1.40

CI excludes the null - significant

More results

Among 41 990 patients, 23 101 (55%) had a moderate to severe traumatic brain injury.

6 days (3-12), p<0.0001).

The probability of delayed withdrawal increased non-linearly with increasing complication burden, plateauing near 100% after seven complications, with the first four having the greatest marginal effect.

“

Conclusion · 1 of 3

Withdrawal of life-sustaining treatment occurs earlier in patients with moderate to severe traumatic brain injury and appears to be driven by distinct factors. Complications may serve as practical triggers for goals-of-care discussions.

Conclusion · 2 of 3

In polytrauma patients with moderate to severe traumatic brain injury, withdrawal decisions appear to be predominantly influenced by factors related to neurological injury.

Conclusion · 3 of 3

These findings support pursuing a more nuanced approach to palliative care research in the trauma intensive care unit.

Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.

Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.

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