Effect of intensity of care on mortality and withdrawal of life-sustaining therapies in severe traumatic brain injury patients : a post-hoc analysis of a multicenter cohort study

Authors: Gerges, Peter Raouf Aziz
Advisor: Turgeon-Fournier, Alexis
Abstract: Introduction and objectives Traumatic brain injury (TBI) is a major health problem. In severe TBI, better outcomes and reduced mortality were shown in trauma centers providing high intensity of treatment and monitoring. Mortality as well as incidence of withdrawal of life-sustaining therapies were found to vary among different trauma centers. Our study aimed to evaluate the effect of intensity of care for severe TBI on the incidence of withdrawal of life-sustaining therapy and mortality. Methods Our study is post-hoc analysis of a Canadian multicenter retrospective cohort study of patients with severe TBI (n = 720). We defined the intensity of care using interventions performed in ICU. They were categorized into 1) TBI related interventions, 2) interventions non-specific to TBI, and according to type of interventions: 1) medical, 2) surgical, and 3) diagnostic interventions. The effect of intensity of care, on mortality and the withdrawal of life-sustaining therapies, was evaluated with adjusted Cox proportional-hazards regression analyses of time-to-event data. Results The intensity of care was associated with decreased mortality (HR 0.69, 95% CI 0.63–0.74, p<0.0001) and decreased withdrawal of life support (HR 0.73, 95% CI 0.67–0.79, p<0.0001). The associations with outcomes were also significant for both the intensity of interventions specific to TBI and general ICU interventions. The associations with outcomes also maintained their significance with medical and diagnostic components of care but were not significant with surgical component of care. Conclusion We observed a significant association between the overall intensity of care, defined by the different interventions commonly used, on mortality and on the incidence of withdrawal of life-sustaining therapies in severe TBI. This association was present whether interventions were specific or not specific to TBI, as well as whether they were medical or diagnostic interventions.
Document Type: Mémoire de maîtrise
Issue Date: 2017
Open Access Date: 31 August 2018
Permalink: http://hdl.handle.net/20.500.11794/30951
Grantor: Université Laval
Collection:Thèses et mémoires

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