Tanizaki Shinsuke, Toma Yasuo, Miyashita Katsuyoshi, Maeda Shigenobu
Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan.
Department of Neurosurgery, Fukui Prefectural Hospital, Fukui, Japan.
World Neurosurg X. 2022 Oct 4;17:100144. doi: 10.1016/j.wnsx.2022.100144. eCollection 2023 Jan.
There is little evidence on the factors influencing the decision to withdraw or continue life-sustaining treatment in the setting of severe traumatic brain injury in Japanese institutions. We investigated the factors associated with the withdrawal or withholding of life-sustaining treatment (WLST) for severe traumatic brain injury at a single Japanese institution.
A total of 161 patients with severe traumatic brain injury were retrospectively reviewed. Patient characteristics and injury types were compared between patients with and without the WLST.
Of the 161 patients, 87 (54%) died and 52 (32%) decided to undergo WLST. In 98% of the WLST cases, the decision was made within 24 h of admission. The mean duration between WLST and death was 2 days. The predicted probabilities for mortality and unfavorable outcomes were highest in patients with WLST within 24 h. Patients with WLST were older and had a higher frequency of falls on the ground, ischemic heart disease, and acute subdural hemorrhage than those without WLST.
The decisions of almost all WLST cases were made within 24 h of admission for severe traumatic brain injury in a Japanese institution because of Japanese patients' religious and cultural backgrounds.
在日本医疗机构中，关于影响重度创伤性脑损伤患者维持生命治疗撤减或继续决策的因素，相关证据较少。我们调查了日本一家机构中重度创伤性脑损伤患者维持生命治疗撤减或 withhold（此处可能有误，推测是withholding，暂按“撤减或停止”翻译）（WLST）的相关因素。
对161例重度创伤性脑损伤患者进行回顾性研究。比较了接受和未接受WLST患者的患者特征及损伤类型。
161例患者中，87例（54%）死亡，52例（32%）决定接受WLST。在98%的WLST病例中，决策在入院24小时内做出。WLST至死亡的平均时长为2天。入院24小时内接受WLST的患者死亡率和不良结局的预测概率最高。接受WLST的患者比未接受WLST的患者年龄更大，摔倒在地、患有缺血性心脏病和急性硬膜下出血的频率更高。
由于日本患者的宗教和文化背景，在日本一家机构中，几乎所有重度创伤性脑损伤患者的WLST决策都是在入院24小时内做出的。
