Insurance Type and Withdrawal of Life-Sustaining Therapy in Critically Injured Trauma Patients
Authors' conclusion
In this cohort study of US adult trauma patients who were critically injured, patients who were uninsured underwent earlier WLST compared with those with private or Medicaid insurance.
Study context
- Population
- Adult trauma patients injured 2017–2020 requiring ICU stay at US level I and II trauma centres (Trauma Quality Improvement Program (TQIP) registry); excluded: died on arrival or in ED, preexisting do not resuscitate directive12,962 (4.2%) underwent withdrawal of life-sustaining therapy (WLST)
- Participants
- 307,731 patients
- Exposure
- Uninsured vs private insurance vs Medicaid
- Private insurancen = 160,809reference
- Medicaidn = 88,233
- Uninsuredn = 58,689
- Outcome
- Time to WLST
Methodological detailsmulticentre registry, adjusted time-to-event analysis, clustering by hospital
- Multicentre registry
- Adjusted time-to-event analysis
- Clustering by hospital
Main finding
As reported in the abstract
Hazard ratio (95% CI)
Uninsured vs Private insurance
1.54(1.46–1.62)
Uninsured vs Medicaid
1.47(1.39–1.55)
Observational data: associations, not effects.
Further findings
Sensitivity analyses (excluding deaths within 48 h; nonwithdrawal death as competing risk)
- Finding robust to sensitivity analyses
Original publication
Insurance Type and Withdrawal of Life-Sustaining Therapy in Critically Injured Trauma Patients. JAMA Netw Open. Published 1 July 2024. doi:10.
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