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  • End of Life Discussion in Patients with Severe Traumatic Brain Injury

    Final Number:

    Martina Stippler MD; Emma Nelton; Alexandra Dionne; Malia McAvoy

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Neurosurgeons caring for traumatic brain injury (TBI) patients are often leading end of life discussions. Little is know about this patient group that was thought to have such a poor progosis that an end of life discussion was felt to be warranted. This study investigates the current state of end of life discussion in patients with severe TBI.

    Methods: All patient from 2016 to 2012 with a severe TBI and an end of life discussion documented were included in this retrospective analysis. We abstracted patient characteristics, parameters of injury severity and parameters of the end of life meeting including but not limited to: services and family present, outcome, location, and frequency.

    Results: Data of 68 patient were analyzed. About 2/3 had a GCS of 3. The mean age was 63. Only 9% of patient had an advanced directives in place. Having a HCP in place did not make it more likely to make a decision during the first end of life dicussion. 32% of patients who had an end-of-life discussion during their admission underwent a neurosurgical intervention of those 79% died. 75% of the meetings were held in the ICU and 16% in the ED. The median time between terminal extubation and death was 4 hours and 17 minutes. All patients (16%) who's surrogate decision maker opted for continued care had a tracheostomy and feeding tube placed and were discharged to a long term care facility.

    Conclusions: Only a 1/3 of the patient underwent a surgical proceed indicating that end of life discussion can help prevent life prolonging but not life restoring surgeries. Patient that underwent surgery has a high mortality but If the desicion was made to continue care patients survived. Understanding end of life discussions can improve goal-concordant care and prevent unnecessariy surgeries.

    Patient Care: Emphasizing end of life discussion can result in a greater goal-concordant, fewer unnecessary surgeries, decreased healthcare costs, and effect psychosocial stress and grief in surrogate decision.

    Learning Objectives: 1. Describe the importance of end of life discussion. 2. Know about parameters that influence end of life discussion. 3. Be informed about ubiquity of unnecessary procedures in this patient group.


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