Mishra Varun, Bath Jennifer, Harvey Ellen, Martinez Melissa, Weppner Justin
Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA.
Brain Inj. 2025;39(8):689-696. doi: 10.1080/02699052.2025.2472197. Epub 2025 Mar 4.
To evaluate the correlation between withdrawal of life-sustaining therapy (WLST) and established prognostic indicators, as well as identify additional factors that may influence the timing of WLST.
This retrospective case-control study examined adult patients admitted between 8/1/18 and 7/31/21 with severe TBI. A case group of 164 individuals who underwent WLST after TBI was matched 1:1 to a control group of 164 individuals with TBI who did not undergo WLST. Clinical indicators of poor prognosis were recorded, and functional recovery of control subjects was evaluated using Glasgow Outcome Scale Extended (GOSE).
The study involved 328 individuals (66 ± 19.9 years). Significant findings revealed lower GCS scores and shorter hospital stays in the case group compared to controls. Bilaterally absent pupillary responses were more common in cases (54.8%) and associated with shorter time to WLST and poorer functional outcomes in controls. Palliative care consultations and DNR code status were associated with time to WLST and functional outcomes. Non-geriatric control patients had better functional outcomes at follow-up (GOSE 6.3 ± 1.7) than geriatric patients (3.1 ± 1.5).
These findings emphasize the importance of standardized guidelines, objective indicators, and avoiding nihilism in making WLST decisions as many control subjects achieved functional recovery at varying levels of independence.
评估维持生命治疗的撤除（WLST）与既定预后指标之间的相关性，并确定可能影响WLST时机的其他因素。
这项回顾性病例对照研究检查了2018年8月1日至2021年7月31日期间收治的重度创伤性脑损伤成年患者。将164例创伤性脑损伤后接受WLST的患者组成的病例组与164例未接受WLST的创伤性脑损伤患者组成的对照组进行1:1匹配。记录预后不良的临床指标，并使用扩展格拉斯哥预后量表（GOSE）评估对照组患者的功能恢复情况。
该研究纳入了328例患者（66±19.9岁）。显著发现显示，与对照组相比，病例组的格拉斯哥昏迷量表（GCS）评分更低，住院时间更短。双侧瞳孔反应消失在病例组中更为常见（54.8%），且与对照组中WLST时间缩短和功能结局较差相关。姑息治疗会诊和“不要复苏（DNR）”代码状态与WLST时间和功能结局相关。非老年对照组患者在随访时的功能结局（GOSE 6.3±1.7）优于老年患者（3.1±1.5）。
这些发现强调了标准化指南、客观指标以及在做出WLST决策时避免虚无主义的重要性，因为许多对照组患者在不同程度的独立水平上实现了功能恢复。
