Evidence map›Paper›PMID 28441973›Full record

ArticleScandinavian journal of trauma, resuscitation and emergency medicine2017

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center.

Annette Robertsen, Reidun Førde, Nils Oddvar Skaga, Eirik Helseth

Abstract read
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In one paragraph

Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Annette RobertsenDepartment of Anesthesiology and Critical Care, Oslo University Hospital, Ullevål, P.O.Box 4950, Nydalen, N-0424, Oslo, Norway. anerob@ous-hf.no.ORCID http://orcid.org/0000-0001-6621-9732
Reidun FørdeCentre for Medical Ethics, University of Oslo, P.O.Box 1130, Blindern, N-0318, Oslo, Norway.
Nils Oddvar SkagaDepartment of Anesthesiology and Critical Care, Oslo University Hospital, Ullevål, P.O.Box 4950, Nydalen, N-0424, Oslo, Norway.
Eirik HelsethDepartment of Clinical Medicine, University of Oslo, Oslo, Norway.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting.

methodsA retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs.

resultsTLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1-652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients' preferences were found in only 7% of cases. DISCUSSION: Clinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.

conclusionTLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

Indexed as

Clinical Decision-MakingAdolescentAdultAgedAged, 80 and overBrain Injuries, TraumaticHumansMiddle AgedNorwayRegistriesResuscitation OrdersRetrospective StudiesTrauma CentersWithholding TreatmentYoung AdultDecision-makingFutilityPotentially inappropriate treatmentTraumatic brain injuryWithholding treatment

Identifiers

PMID28441973
PMCPMC5405474

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.