Pediatric anesthesia & critical care
Withdrawal of Life-Sustaining Treatment for Pediatric Patients With Severe Traumatic Brain Injury
An erratum to this article was published (JAMA Surg, 1 Mar 2024 ↗)
Authors' conclusion
Several patient and injury factors were associated with withdrawal of life-sustaining treatment decision-making for pediatric patients with severe TBI in this study. Variation in withdrawal of life-sustaining treatment practices between trauma centers was observed after adjustment for case mix; this variation was associated with differences in risk-adjusted mortality rates.
Study context
- Population
- Pediatric patients <19 years with severe traumatic brain injury (TBI), 515 North American trauma centres (American College of Surgeons Trauma Quality Improvement Program), 2017–2020
- Participants
- 9,803 patients · 515 trauma centres
- Exposure
- Fourth quartile vs First quartile
- Outcome
- Decision to withdraw life-sustaining treatment (associated factors; residual between-centre variability by median OR)
Methodological detailsmulticentre registry, random intercept multilevel logistic regression, Data analysed January to May 2023
- Multicentre registry
- Random intercept multilevel logistic regression
- Data analysed January to May 2023
Main finding
As reported in the abstract
Median OR (95% CI 1.46-1.62), suggesting residual variation in withdrawal of life-sustaining treatment between centers
1.54
Withdrawal of life-sustaining treatment decision, all children
1003
10.2%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Adjusted mortality by centre quartile of propensity for withdrawal | 1.66 (1.45–1.88) | |
| 0.512Odds ratio (log scale) |
Original publication
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