Over 30% of patients with traumatic brain injury could potentially achieve partial independence 6 months post-injury, challenging the early withdrawal of life-sustaining treatments, according to a study.

The study, published in the Journal of Neurotrauma, provides new insights into the prognostic challenges and potential for recovery in patients with severe traumatic brain injury (TBI) who undergo withdrawal of life-sustaining treatment (WLST). The research utilized data from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study to analyze outcomes in patients post-WLST.

The researchers paired 90 patients from two groups, those who underwent WLST (WLST+) and a demographically and clinically similar group who did not undergo treatment withdrawal (WLST−). Propensity score matching was employed by researchers to facilitate accurate comparisons between the cohorts. Their findings revealed that a considerable number of patients could have potentially survived and achieved partial independence (Glasgow Outcome Scale-Extended [GOSE] score ≥4) 6 months post-injury, had WLST not been implemented.

"Our results support recent calls for a cautionary approach towards early WLST after acute TBI and suggest that a lifetime in a vegetative state or with lower severe disability is not a common outcome, even after a very serious injury," said researchers. "Surrogate decision-makers may be advised that the first few days after TBI are a ‘window of opportunity’ to allow their loved ones to pass away peacefully in the ICU, as WLST in the chronic phase of recovery may be logistically and legally more difficult. Our data may alleviate some of these concerns."

The researchers noted an “absence of published guidelines or individualized algorithms that identify which patients will make a meaningful recovery,” and so most families rely on the clinical team’s decision-making although critical care clinicians don’t follow patients long-term.

The study may help advocate for a more deliberate approach to WLST decisions in severe TBI scenarios, stressing the enhancement of prognostic models and clinical counseling to encompass a wider range of potential outcomes. By broadening the understanding of patient outcomes in severe TBI, this research contributes to the ongoing dialogue regarding ethical decision-making and the management of life-sustaining treatment in critical care settings.

The researchers suggested that further research with larger cohorts and comprehensive clinical data is essential to refine the WLST decision-making process, potentially enhancing both survival rates and quality of life for patients with severe TBI.

The study was conducted using data from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) and was funded by various academic and medical institutions.