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May 17, 2024

Waiting to remove life support may provide a clearer picture of a patient's outlook, study shows

With severe traumatic brain injuries, doctors typically make recommendations within 72 hours. New research suggests it's better to delay the decision for several more days.

Adult Health Brain Injuries
Life Support decision Thom Carroll/For PhillyVoice

The decision on whether to remove a patient with a traumatic brain injury from life support typically is made within 72 hours. But a new study suggests that time frame is too short.

Families who must decide whether to remove a loved one from life support following a traumatic brain injury may be better off delaying that decision for several days beyond the customary timeline, new research suggests. 

About 5 million people are hospitalized worldwide with TBIs each year. For those that are not declared brain dead, the decision of whether to remove life support, like ventilators, is typically made within 72 hours and often based on physician recommendations. But a study suggests that time frame is too short, because some people taken off life support that early may be capable of recovering to live with some independence. 

Using data from 1,392 patients hospitalized with TBIs, researchers compared patients who died after they were removed from life support to similar patients who were left on life support. They used this as the basis for projecting alternative outcomes for people who were removed from life support. 

Had these patients remained on life support, most would have died at the hospital within six days, the study found. But very few would have remained comatose, and 42% of survivors would have resumed some level of independence within six months.  

Though their findings are limited, researchers said delaying the decision on whether to remove life support by a few days may provide a clearer picture of a patient's chance for recovery. 

"Our findings support a more cautious approach to making early decisions on withdrawal of life support," said study author Yelena Bodien, a researcher at Massachusetts General Hospital. "Traumatic brain injury is a chronic condition that requires long-term follow-ups to understand patient outcomes. Delaying decisions regarding life support may be warranted to better identify patients whose condition may improve."

The study's findings suggest there is a cyclical effect involving decisions on life support removal. Based on outcomes data, clinicians assume patients will do poorly, resulting in recommendations to withdraw life support, the researchers said. This increases rates of poor outcomes, leading to more decisions to remove life support. 

Though the study found a lifetime comatose state is unlikely, and severe disabilities are less common. But many survivors end up with permanent disabilities, and very few make full recoveries. The study stressed that may factor into families' decisions. 

"The relationship between functional recovery and quality of life, which may be a more meaningful outcome measure, is complex, especially in the absence of pre-injury data," the study says. 

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