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

Background: Trauma-specific palliative care guidelines are limited, and physicians rely heavily on experience to guide goals-of-care discussions, leading to substantial practice variation. Existing literature does not adequately account for the marked heterogeneity among trauma patients. How traumatic brain injury influences the timing and determinants of delayed withdrawal of life-sustaining treatment in patients with concomitant major extracranial injuries remains poorly understood. Methods: We conducted a retrospective cohort study of patients ≥16 years with withdrawal of life-sustaining treatment in the American College of Surgeons Trauma Quality Improvement Program database (2021-2023). Patients were stratified by the presence of moderate to severe traumatic brain injury. The primary outcome was time to withdrawal of life-sustaining treatment. Our secondary aim was to assess predictors of delayed withdrawal (>75th percentile for each group) using separate binary logistic regression models. Results: Among 41 990 patients, 23 101 (55%) had a moderate to severe traumatic brain injury. Withdrawal occurred earlier in patients with moderate to severe traumatic brain injury (median 4 days (IQR 2-9) vs. 6 days (3-12), p