Evidence map›Paper›PMID 37980485›Full record

Observational studyCritical care (London, England)2023

Factors influencing withdrawal of life-supporting treatment in cervical spinal cord injury: a large multicenter observational cohort study.

Husain Shakil, Armaan K Malhotra, Rachael H Jaffe, Christopher W Smith, Erin M Harrington, Alick P Wang, Eva Y Yuan, Yingshi He, Karim Ladha, Duminda N Wijeysundera and 3 more

Open access · goldAbstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
3.8field-weighted citation impact, top 6% of its field
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

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Review
  2. Article
  3. Review
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

13 authors at 4 institutions in 1 country.

Husain ShakilDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Armaan K MalhotraDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Rachael H JaffeLi Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Christopher W SmithDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Erin M HarringtonDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Alick P WangDivision of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
Eva Y YuanDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Yingshi HeDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Karim LadhaLi Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Duminda N WijeysunderaLi Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Avery B NathensInstitute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Jefferson R WilsonDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Christopher D WitiwDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. Christopher.Witiw@unityhealth.to.
St. Michael's Hospital · CAUniversity of Toronto · CASunnybrook Health Science Centre · CAUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTraumatic spinal cord injury (SCI) leads to profound neurologic sequelae, and the provision of life-supporting treatment serves great importance among this patient population. The decision for withdrawal of life-supporting treatment (WLST) in complete traumatic SCI is complex with the lack of guidelines and limited understanding of practice patterns. We aimed to evaluate the individual and contextual factors associated with the decision for WLST and assess between-center differences in practice patterns across North American trauma centers for patients with complete cervical SCI.

methodsThis retrospective multicenter observational cohort study utilized data derived from the American College of Surgeons Trauma Quality Improvement Program database between 2017 and 2020. The study included adult patients (> 16 years) with complete cervical SCI. We constructed a multilevel mixed effect logistic regression model to adjust for patient, injury and hospital factors influencing WLST. Factors associated with WLST were estimated through odds ratios with 95% confidence intervals. Hospital variability was characterized using the median odds ratio. Unexplained residual variability was assessed through the proportional change in variation between models.

resultsWe identified 5070 patients with complete cervical SCI treated across 477 hospitals, of which 960 (18.9%) had WLST. Patient-level factors associated with significantly increased likelihood of WLST were advanced age, male sex, white race, prior dementia, low presenting Glasgow Coma Scale score, having a pre-hospital cardiac arrest, SCI level of C3 or above, and concurrent severe injury to the head or thorax. Patient-level factors associated with significantly decreased likelihood of WLST included being racially Black or Asian. There was significant variability across hospitals in the likelihood for WLST while accounting for case-mix, hospital size, and teaching status (MOR 1.51 95% CI 1.22-1.75).

conclusionsA notable proportion of patients with complete cervical SCI undergo WLST during their in-hospital admission. We have highlighted several factors associated with this decision and identified considerable variability between hospitals. Further work to standardize WLST guidelines may improve equity of care provided to this patient population.

Indexed as

Cervical CordSpinal Cord InjuriesAdultFemaleHumansLogistic ModelsMaleRetrospective StudiesWithholding TreatmentEnd-of-life careEquity of careInterfacility variabilityTraumatic spinal cord injuryWithdrawal of life-supporting treatment

Identifiers

PMID37980485
PMCPMC10656773
OpenAlexW4388797375

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.