In "Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study," forthcoming in CMAJ, Alexis Turgeon and colleagues examined the treatment of traumatic brain injury across Canadian hospitals. They report "considerable variability" in the rate of withdrawal of life-sustaining therapy. At some facilities withdrawal is quite early, often within three days of ICU admission. Life-sustaining treatment is usually withdrawn because of a poor chance of survival or because of a prognosis incompatible with the patient's wishes. But the authors conclude that since "there are few accurate and useful prediction tools" prognostication for these patients relies heavily upon "physicians' perceptions" and "physicians' practice patterns." This, they suggest, explains wide variation in the rate and speed at which life-sustaining treatment is withdrawn.
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