Neuroanesthesia & neurocritical care
Influence of health insurance on withdrawal of life sustaining treatment for patients with isolated traumatic brain injury: a retrospective multi-center observational cohort study
Authors' conclusion
Our findings highlight the presence of disparate WLST practices independently associated with health insurance status.
Study context
- Population
- Adults (age ≥ 16) with isolated severe traumatic brain injury (TBI) admitted to Trauma Quality Improvement Program centers, 2017–2020
- Participants
- 42,111 adults · 509 trauma centers
- Exposure
- Public insurance or uninsured vs private insurance
- Outcome
- Timing of withdrawal of life sustaining treatment (WLST)
Methodological detailsmulticentre, observational, competing risk survival analysis
- Multicentre
- Observational
- Competing risk survival analysis
Main finding
As reported in the abstract
Timing of WLST (adjusted)
Each group vs privateHazard ratio (95% CI)
Public
1.07(1.02–1.12)
Uninsured
1.29(1.18–1.41)
Observational data: associations, not effects.
Further findings
Withdrawal of life sustaining treatment (WLST) events, whole cohort
- WLST events
- 10,771 (25.6%)
- Higher unadjusted incidence of WLST in public insurance vs private or uninsured
Access to rehabilitation at discharge
- Lower for publicly insured and uninsured vs private insurance
Between-center residual variation in WLST (median OR)
- Median odds ratio (MOR)
- 1.49 (95% CI 1.43-1.55)
- Accounting for case-mix
Original publication
Influence of health insurance on withdrawal of life sustaining treatment for patients with isolated traumatic brain injury: a retrospective multi-center observational cohort study. Crit Care. Published 18 July 2024. doi:10.
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