Background: Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied.\nThis study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma\nsetting.\nMethods: A retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH).\nProspectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart\nreview regarding TLDs.\nResults: TLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59\ncases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding\nof neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD\nwas made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent\n(20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients.\nThe median time from the decision to death was 2 days (range 1ââ?¬â??652). TLDs were documented in 93% of\nin-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD\ngroup cases. Family interaction and multi-team discussions were documented in >88% of cases, but no\nadvanced directives were found, and notifications of patientsââ?¬â?¢ preferences were found in only 7% of cases.\nDiscussion: Clinicians should consider limiting treatment if continued treatment is not in the patients best\ninterest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.\nConclusion: TLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context\nneed to be further explored.
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