Severe traumatic brain injury (TBI) affects over five million people annually and is a leading cause of hospitalizations and deaths worldwide. Predicting outcomes following a brain injury can be challenging, and families are often faced with decisions regarding continuing or withdrawing life support measures shortly after the injury occurs. In a recent study, researchers from Mass General Brigham analyzed data from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study to explore potential outcomes for TBI patients for whom life support was withdrawn. They found that some patients may have survived and regained some level of independence even after life support was withdrawn, suggesting that delaying decisions on withdrawing life support could be beneficial for certain individuals.
Families are typically asked to make decisions regarding withdrawing life support measures, such as mechanical breathing, within 72 hours of a brain injury. Physicians often convey information suggesting a poor neurologic prognosis as the main reason for families choosing to withdraw life support. However, there are currently no clear guidelines or algorithms to determine which patients with severe TBI are likely to recover. By utilizing data collected over a 7.5-year period on 1,392 TBI patients in intensive care units at 18 United States trauma centers, the researchers developed a mathematical model to predict the likelihood of withdrawal of life-sustaining treatment based on various factors. They then matched individuals for whom life support was not withdrawn to those with similar scores for whom life support was withdrawn.
The study found that a significant proportion of TBI patients for whom life support was withdrawn either died or recovered some level of independence in daily activities within six months of the injury. More than 40 percent of the group for whom life support was not withdrawn recovered some level of independence, and remaining in a vegetative state was an unlikely outcome by six months post-injury. Notably, none of the patients who died in the study were declared brain dead. The researchers suggest that a self-fulfilling prophecy may be occurring, with clinicians assuming poorer outcomes based on data leading to decisions to withdraw life support, ultimately resulting in increased poor outcomes rates and more decisions to withdraw life support.
The authors propose that further studies with larger sample sizes are needed to better understand the varying recovery trajectories for TBI patients. They emphasize the importance of long-term follow-ups to comprehend patient outcomes since traumatic brain injury is a chronic condition. The researchers advocate for a more cautious approach to making early decisions on withdrawing life support, suggesting that delaying these decisions may help identify patients whose condition could improve over time. The study was published in the Journal of Neurotrauma on May 13 and highlights the complexity of predicting outcomes for TBI patients and the need for further research in this area to improve patient care and outcomes.