ArticleJournal of neurotrauma2024
Recovery Potential in Patients Who Died After Withdrawal of Life-Sustaining Treatment: A TRACK-TBI Propensity Score Analysis.
Article in Journal of neurotrauma, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
- Clinicians' Approaches to Prognostication After Traumatic Brain Injury and Cardiac Arrest: A Multi-Hospital, Qualitative Study.Neurocritical care · 2026Article
- Updates in Management of Acute Disorders of Consciousness After Traumatic Injury.Brain sciences · 2026Review
- Neurological Outcome Beyond the ICU in Patients with Severe Acute Brain Injury: A Knowledge gap for ICU Teams.Journal of intensive care medicine · 2026Observational
- Trajectories of daily inpatient blood biomarkers of physiological function improve mortality and morbidity prognostic model performance for patients with severe traumatic brain injury.Neurocritical care · 2026Article
- Serial measurements of neuron specific enolase, glial fibrillary acidic protein and neurofilament light for mortality prediction in patients with severe acute brain injury in the ICU.Clinical chemistry and laboratory medicine · 2026Article
- Reporting practices and impact of withdrawal of life-sustaining treatment on outcomes in acute brain injury clinical trials: a literature review and simulation study.Critical care (London, England) · 2026Review
- Hospital mortality, withdrawal of life-sustaining therapy decisions and early secondary brain insults for critically ill traumatic brain injury patients in England, Wales and Northern Ireland (2009-2024): an observational cohort study.The Lancet regional health. Europe · 2026Article
- A survey of physicians perceptions of disability outcomes after hypothetical traumatic brain injury.Scientific reports · 2026Article
- 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.Trauma surgery & acute care open · 2026Article
- Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: Report of the 2025 ISICEM roundtable.Intensive care medicine · 2026Review
- Covert consciousness: what's in a name?Brain : a journal of neurology · 2025Article
- Estimating bias from withdrawal of life sustaining treatment in clinical trials.Critical care (London, England) · 2025Review
- Clinical Assessment on Days 1-14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group.Journal of neurotrauma · 2025Review
- Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics.Critical care (London, England) · 2025Review
- Implementation of a specialized neuroprognostication consultation program and associated provider attitudes: A survey-based study.Resuscitation plus · 2025Article
- Sleep spindles as a predictor of cognitive motor dissociation and recovery of consciousness after acute brain injury.Nature medicine · 2025Observational
- Caring for Coma after Severe Brain Injury: Clinical Practices and Challenges to Improve Outcomes: An Initiative by the Curing Coma Campaign.Neurocritical care · 2025Article
- Timing of neuroprognostication in the ICU.Current opinion in critical care · 2025Review
- Optimizing Neurobehavioral Assessment for Patients with Disorders of Consciousness: Proposal of a Comprehensive Pre-Assessment Checklist for Clinicians.Brain sciences · 2025Article
- Accounting for Withdrawal of Life-Sustaining Treatment in the Analysis of Traumatic Brain Injury Studies.Neurotrauma reports · 2025Article
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9 authors.
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Abstract
Among patients with severe traumatic brain injury (TBI), there is high prognostic uncertainty but growing evidence that recovery of independence is possible. Nevertheless, families are often asked to make decisions about withdrawal of life-sustaining treatment (WLST) within days of injury. The range of potential outcomes for patients who died after WLST (WLST+) is unknown, posing a challenge for prognostic modeling and clinical counseling. We investigated the potential for survival and recovery of independence after acute TBI in patients who died after WLST. We used Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) data and propensity score matching to pair participants with WLST+ to those with a similar probability of WLST (based on demographic and clinical characteristics), but for whom life-sustaining treatment was not withdrawn (WLST-). To optimize matching, we divided the WLST- cohort into tiers (Tier 1 = 0-11%, Tier 2 = 11-27%, Tier 3 = 27-70% WLST propensity). We estimated the level of recovery that could be expected in WLST+ participants by evaluating 3-, 6-, and 12-month Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale outcomes in matched WLST- participants. Of 90 WLST+ participants (80% male, mean [standard deviation; SD] age = 59.2 [17.9] years, median [IQR] days to WLST = 5.4 [2.2, 11.7]), 80 could be matched to WLST- participants. Of 56 WLST- participants who were followed at 6 months, 31 (55%) died. Among survivors in the overall sample and survivors in Tiers 1 and 2, more than 30% recovered at least partial independence (GOSE ≥4). In Tier 3, recovery to GOSE ≥4 occurred at 12 months, but not 6 months, post-injury. These results suggest a substantial proportion of patients with TBI and WLST may have survived and achieved at least partial independence. However, death or severe disability is a common outcome when the probability of WLST is high. While further validation is needed, our findings support a more cautious clinical approach to WLST and more complete reporting on WLST in TBI studies.
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