Predictors of withdrawal of life-sustaining therapies in older adults with TBI and a modified frailty index score.
Publication/Presentation Date
3-18-2025
Abstract
BACKGROUND: Withdrawal-of-life-sustaining-therapies (WLST) in patients with traumatic brain injury (TBI) is a complex decision-making process. The clinical factors related to WLST in older adults with TBI are currently poorly understood. The present study aims to determine the clinical predictors of WLST in older patients with TBI.
METHODS: All patients ≥ 65 years old with TBI (Head Abbreviated Injury Scale Score ≥ 3) were identified from the Geriatric TBI Database, a prospective registry of patients admitted to 45 trauma centers nationwide with TBI between 2017-2019. We collected factors related to past medical history, baseline demographic data, clinical presentation, TBI sub-type, neurosurgical interventions, and do-not-attempt-resuscitation (DNAR) orders. The primary outcome measure was WLST. Binary logistic regression was subsequently performed to determine factors independently associated with WLST.
RESULTS: A total of 1600 patients were identified. The median age was 80 years old and 48.6 % of patients were male. In this cohort, 120 patients (7.5 %) underwent WLST. A logistic regression model revealed that Glasgow Coma Scale (GCS) (OR 0.82; 95 %-CI 0.77--0.87), cerebral edema (3.2; 1.5-7.0), craniotomy/craniectomy (2.5; 1.4-4.4), and DNAR (8.8; 5.5-14.3) were all independently associated with WLST. This model demonstrated excellent discrimination ability with a concordance statistic of 0.935.
CONCLUSIONS: This study demonstrates that patients ≥ 65 years old with poor initial GCS, cerebral edema, craniotomy/craniectomy, and DNAR were all independently associated with WLST. Pre-injury frailty was not associated with WLST. Further studies are needed to evaluate the prognostic value of frailty indices in the management of patients with TBI.
Volume
135
First Page
111191
Last Page
111191
ISSN
1532-2653
Published In/Presented At
Francis, J. J., Kashkoush, A. I., Ho, V. P., Roach, M. J., Kelly, M. L., & American Association for the Surgery of Trauma GERI-TBI Study Group (2025). Predictors of withdrawal of life-sustaining therapies in older adults with TBI and a modified frailty index score. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 135, 111191. Advance online publication. https://doi.org/10.1016/j.jocn.2025.111191
Disciplines
Medicine and Health Sciences
PubMedID
40107005
Department(s)
Department of Surgery
Document Type
Article