Factors influencing withdrawal of life‑supporting treatment in cervical spinal cord injury: a large multicenter observational cohort study

Critical Care, 2023 · DOI: https://doi.org/10.1186/s13054-023-04725-x · Published: November 8, 2023

Spinal Cord Injury Surgery Palliative Care

Simple Explanation

This study looks at factors that influence the decision to withdraw life-supporting treatment (WLST) in patients with complete cervical spinal cord injury (SCI). It uses data from multiple trauma centers across North America. The researchers analyzed data from 2017 to 2020, examining patient characteristics, injury details, and hospital factors to see what makes WLST more or less likely. They also looked at how much WLST practices vary between different hospitals. The study found that factors like age, sex, race, insurance type, and the severity of the injury all play a role in the decision for WLST. There was also significant variation in WLST practices between hospitals, suggesting that guidelines for WLST may need to be standardized.

Study Duration

2017 to 2020

Participants

5070 adult patients with complete cervical SCI

Evidence Level

Not specified

Key Findings

1
Advanced age, male sex, white race, prior dementia, low Glasgow Coma Scale score, pre-hospital cardiac arrest, SCI level of C3 or above, and concurrent severe head or thorax injury were associated with increased likelihood of WLST.
2
Being racially Black or Asian was associated with a decreased likelihood of WLST.
3
Significant variability exists across hospitals in the likelihood of WLST, even after accounting for patient case-mix, hospital size, and teaching status.

Research Summary

This multicenter study identified factors associated with WLST in patients with complete cervical SCI. These factors include patient demographics like age, sex, race, and insurance, as well as injury-related factors. The study revealed significant variation in WLST practice across North American institutions, highlighting potential inconsistencies in end-of-life care for this patient population. The findings suggest a need for standardized WLST guidelines to improve the quality and equity of care for patients with complete cervical SCI.

Practical Implications

Standardize WLST Guidelines

Develop and implement standardized guidelines for WLST in patients with complete cervical SCI to ensure more consistent and equitable care across different hospitals.

Address Disparities

Investigate and address the factors contributing to racial and socioeconomic disparities in WLST decisions to ensure all patients receive equitable end-of-life care.

Inform Decision-Making

Use the identified patient and injury-related factors to inform clinical decision-making and discussions with patients and families regarding WLST options.

Study Limitations

1
Potential misclassification in data elements due to reliance on secondary data sources.
2
Limited to variables available in the TQIP database, excluding potentially relevant factors like patient religious affiliation and family social dynamics.
3
Generalizability may be limited as TQIP data derives from trauma centers with a focus on quality of care, potentially underestimating practice variation.

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