Mayo Clinic, Rochester, MN, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Mayo Clinic, Rochester, MN, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Injury. 2019 May;50(5):1064-1067. doi: 10.1016/j.injury.2019.01.024. Epub 2019 Jan 14.
Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources.
Trauma Quality Improvement Program (2013-2014) patients who underwent WLST were identified. WLST patients were compared to those who died with full supportive care (FSC). Patients were excluded for death within 24 h of admission, or head AIS > 3. Intergroup comparisons were by student's t tests or Wilcoxon rank sum tests; significance for p < 0.05.
We identified 3471 total injured patients without major TBI who died > 24 h after admission. Of these death after WLST occurred in 2301 (66% of total). This group had a mean age of 66.8 years; 35.7% were women, and 95.4% sustained blunt injury. WLST patients had a higher ISS (21.6 vs. 12.5, p = 0.001), more in-hospital complications (71.4% vs. 41.6%, p = < 0.0001), and a longer ICU length of stay (8.9 days vs. 7.5 days, p = <0.0001) compared to patients who died with FSC.
WLST occurs in two-thirds of injured patients without severe TBI who die in the hospital. In-hospital complications are more frequent in this patient group than those who die with FSC. Early palliative care consultation may improve patient and family satisfaction after acute injury when the timeframe to leverage such services is significantly condensed.
许多受伤的患者或其家属在遭受严重创伤后，做出了艰难的决定，停止维持生命的治疗（WLST）。虽然这一人群在严重创伤性脑损伤（TBI）的背景下已经得到了研究，但对于没有 TBI 而接受 WLST 的患者知之甚少。我们试图描述可能受益于尽早使用生命末期资源的患者。
从创伤质量改进计划（2013-2014 年）中确定了接受 WLST 的患者。将 WLST 患者与接受充分支持性护理（FSC）但死亡的患者进行比较。排除入院后 24 小时内死亡或头部 AIS ＞3 的患者。组间比较采用学生 t 检验或 Wilcoxon 秩和检验；p＜0.05 为差异有统计学意义。
我们共确定了 3471 例无重大 TBI 的受伤患者，他们在入院后＞24 小时死亡。在这些死亡患者中，有 2301 例（占总数的 66%）在 WLST 后死亡。这组患者的平均年龄为 66.8 岁；35.7%为女性，95.4%为钝器伤。与接受 FSC 治疗但死亡的患者相比，WLST 患者的 ISS 更高（21.6 比 12.5，p=0.001），住院并发症更多（71.4%比 41.6%，p＜0.0001），ICU 住院时间更长（8.9 天比 7.5 天，p＜0.0001）。
在因伤住院死亡的无严重 TBI 患者中，有三分之二的患者接受了 WLST。与接受 FSC 治疗但死亡的患者相比，该患者群体的住院并发症更为常见。在急性损伤时，此类服务的时间框架明显缩短，尽早进行姑息治疗咨询可能会提高患者和家属的满意度。
