Some with TBI who underwent withdrawal of life-sustaining treatment could have regained at least partial independence
By Elana Gotkine HealthDay Reporter
MONDAY, May 13, 2024 (HealthDay News) — A substantial proportion of patients with traumatic brain injury (TBI) who undergo withdrawal of life-sustaining treatment (WLST) could have survived and regained at least partial independence, according to a study published online May 13 in the Journal of Neurotrauma.
William R. Sanders, from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues examined the potential for survival and recovery of independence after acute TBI in patients who died after WLST. Transforming Research and Clinical Knowledge in TBI data and propensity score matching were used to pair participants with WLST (WLST+) versus those with a similar probability of WLST but for whom treatment was not withdrawn (WLST−). The WLST− cohort was divided into tiers to optimize matching (tier 1, 0 to 11 percent; tier 2, 11 to 27 percent; tier 3, 27 to 70 percent WLST propensity). The level of recovery that could be expected in WLST+ participants was estimated by evaluating three-, six-, and 12-month Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale outcomes in matched WLST− participants.
Eighty WLST+ participants were matched to WLST− participants. The researchers found that 55 percent of the 56 WLST− participants who were followed at six months died. More than 30 percent of the survivors in the overall sample and in tiers 1 and 2 recovered at least partial independence (GOSE ≥4). Recovery to GOSE ≥4 occurred at 12, but not six months, postinjury in tier 3.
“Our findings provide evidence that some patients who die after WLST may have recovered independence months after injury,” the authors write.
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