种族和社会经济地位对青少年创伤性脑损伤治疗的影响。

Race and Socio-Economic Status Impact Withdrawal of Treatment in Young Traumatic Brain Injury.

机构信息

College of Medicine (T.J), University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, Tennessee, USA.

Division of Trauma and Surgical Critical Care (B.S., L.E.K., K.A.J., F.D.M.), Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, Tennessee, USA.

出版信息

J Pain Symptom Manage. 2024 Nov;68(5):499-505. doi: 10.1016/j.jpainsymman.2024.07.035. Epub 2024 Aug 7.

DOI:10.1016/j.jpainsymman.2024.07.035

PMID:39097244

Abstract

CONTEXT

Withdrawal of life-sustaining therapies (WDLST) in young individuals with traumatic brain injury (TBI) is an overwhelming situation often made more stressful by socioeconomic factors that shape health outcomes. Identifying these factors is crucial to developing equitable and goal-concordant care for patients and families.

OBJECTIVES

We aimed to identify predictors of WDLST in young patients with 1-TBI. We hypothesized uninsured payment method, race, and co-morbid status are associated with WDLST.

METHODS

We queried the 2021 Trauma Quality Improvement Program database for patients <45 years with TBI. Patients with WDLST were compared to patients without WDLST. Multivariable logistic regression (MLR) was performed.

RESULTS

61,115 patients were included, of whom 2,487 (4.1%) underwent WDLST. Patients in the WDLST cohort were older (29 vs 27, P<0.001), more likely to suffer from a penetrating mechanism (29% vs 11%, P<.0001), and have uninsured (22% vs 18%) or other payment method (5% vs 3%) when compared to the non-WDLST cohort. MLR identified age (AOR:1.019, 95% CI 1.014-1.024, P<.0001), non-Hispanic ethnicity (AOR:1.590, 95% CI 1.373-1.841, P<.0001), penetrating mechanism (AOR:3.075, 95% CI 2.727-3.467, P<.0001), systolic blood pressure (AOR: 0.992, 95% CI 0.990-0.993, P<0.0001), advanced directive (AOR:4.987, 95% CI 2.823-8.812, P<.0001), cirrhosis (AOR:3.854, 95% CI 2.641-5.625, P<.0001), disseminated cancer (AOR:6.595, 95% CI 2.370-18.357, P=0.0003), and interfacility transfer (AOR:1.457, 95% CI 1.295-1.640, P<0.0001) as factors associated with WDLST. Black patients were less likely to undergo WDLST when compared to white patients (AOR:0.687, 95% CI 0.603-0.782, P<.0001).

CONCLUSION

The decision for WDLST in young patients with severe TBI may be influenced by cultural and socioeconomic factors in addition to clinical considerations.

摘要

背景

对于创伤性脑损伤（TBI）的年轻患者，停止生命维持治疗（WDLST）是一种压倒性的情况，社会经济因素往往会使这种情况更加紧张，这些因素会影响健康结果。确定这些因素对于为患者和家庭制定公平和符合目标的护理至关重要。

目的

我们旨在确定 1-TBI 年轻患者 WDLST 的预测因素。我们假设无保险支付方式、种族和合并症状态与 WDLST 相关。

方法

我们在 2021 年创伤质量改进计划数据库中查询了年龄<45 岁的 TBI 患者。将接受 WDLST 的患者与未接受 WDLST 的患者进行比较。进行多变量逻辑回归（MLR）。

结果

共纳入 61115 例患者，其中 2487 例（4.1%）接受了 WDLST。与非 WDLST 组相比，WDLST 组患者年龄更大（29 岁 vs 27 岁，P<0.001），更有可能遭受穿透性损伤机制（29% vs 11%，P<.0001），且无保险（22% vs 18%）或其他支付方式（5% vs 3%）。MLR 确定了年龄（AOR：1.019，95%CI 1.014-1.024，P<.0001）、非西班牙裔（AOR：1.590，95%CI 1.373-1.841，P<.0001）、穿透性损伤机制（AOR：3.075，95%CI 2.727-3.467，P<.0001）、收缩压（AOR：0.992，95%CI 0.990-0.993，P<0.0001）、预先指示（AOR：4.987，95%CI 2.823-8.812，P<.0001）、肝硬化（AOR：3.854，95%CI 2.641-5.625，P<.0001）、播散性癌症（AOR：6.595，95%CI 2.370-18.357，P=0.0003）和医院间转移（AOR：1.457，95%CI 1.295-1.640，P<.0001）与 WDLST 相关。与白人患者相比，黑人患者接受 WDLST 的可能性更低（AOR：0.687，95%CI 0.603-0.782，P<.0001）。