Table 1.
Baseline characteristics of deceased patients
| WLSM status | Timing of WLSM | |||
|---|---|---|---|---|
| No WLSM n = 38 |
WLSM n = 229 |
< 72 h n = 117 |
≥ 72 h n = 112 |
|
| Patient characteristics | ||||
| Age (median [IQR]) | 67.50 [52.00, 76.50] | 60.00 [39.00, 74.00] | 61.00 [37.00, 75.00] | 60.00 [40.00, 71.25] |
| Sex male (%) | 33 (86.8) | 167 (72.9) | 86 (73.5) | 81 (72.3) |
| Pre-injury ASAPS classification (%) | ||||
| A normal healthy patient | 12 (36.4) | 86 (42.8) | 46 (44.2) | 40 (41.2) |
| A patient with a mild systemic disease | 13 (39.4) | 79 (39.3) | 40 (38.5) | 39 (40.2) |
| A patient with a severe systemic disease | 8 (24.2) | 36 (17.9) | 18 (17.3) | 18 (18.6) |
| Any medical history (%) | 24 (64.9) | 141 (61.8) | 71 (60.7) | 70 (63.1) |
| Region | ||||
| Western Europe | 12 (31.6) | 119 (52) | 64 (54.7) | 55 (49.1) |
| Eastern Europe | 11 (28.9) | 0 (0) | 0 (0) | 0 (0) |
| Northern Europe | 1 (2.6) | 26 (11.4) | 14 (12) | 12 (10.7) |
| Southern Europe | 9 (23.7) | 52 (22.7) | 28 (23.9) | 24 (21.4) |
| United Kingdom | 5 (13.2) | 32 (14) | 11 (9.4) | 21 (18.8) |
| Baseline characteristics | ||||
| GCS motor baseline (%) | ||||
| 1 | 19 (51.4) | 142 (64.8) | 84 (73.7) | 58 (55.2) |
| 2 | 1 (2.7) | 16 (7.3) | 10 (8.8) | 6 (5.7) |
| 3 | 2 (5.4) | 10 (4.6) | 5 (4.4) | 5 (4.8) |
| 4 | 4 (10.8) | 14 (6.4) | 5 (4.4) | 9 (8.6) |
| 5 | 6 (16.2) | 20 (9.1) | 5 (4.4) | 15 (14.3) |
| 6 | 5 (13.5) | 17 (7.8) | 5 (4.4) | 12 (11.4) |
| Pupils baseline (%) | ||||
| Both reactive | 18 (54.5) | 100 (46.3) | 30 (26.8) | 70 (67.3) |
| One reactive | 2 (6.1) | 21 (9.7) | 13 (11.6) | 8 (7.7) |
| Both unreactive | 13 (39.4) | 95 (44) | 69 (61.6) | 26 (25) |
| Total ISS (median [IQR]) | 34.00 [25.00, 45.00] | 41.00 [26.00, 75.00] | 50.00 [26.00, 75.00] | 35.00 [26.00, 50.00] |
| Major Extracranial Injury (%) | 18 (47.4) | 132 (57.6) | 62 (53) | 70 (62.5) |
| Hypoxia (%) | 7 (20.6) | 43 (21.8) | 27 (26.7) | 16 (16.7) |
| Hypotension (%) | 6 (20) | 47 (22.8) | 30 (28.6) | 17 (16.8) |
| CT characteristics | ||||
| Marshall CT classification (%) | ||||
| I | 1 (3) | 8 (3.8) | 3 (2.8) | 5 (5) |
| II | 6 (18.2) | 24 (11.4) | 6 (5.5) | 18 (17.8) |
| III | 4 (12.1) | 40 (19) | 25 (22.9) | 15 (14.9) |
| IV | 0 (0) | 12 (5.7) | 8 (7.3) | 4 (4.0) |
| V/VI | 22 (66.7) | 126 (60) | 67 (61.5) | 59 (58.4) |
| Anything present on CT (%) | 31 (81.6) | 194 (84.7) | 102 (87.2) | 92 (82.1) |
| Epidural hematoma present on CT (%) | 3 (7.9) | 21 (9.2) | 9 (7.7) | 12 (10.7) |
| Acute Subdural hematoma present on CT (%) | 26 (68.4) | 137 (59.8) | 79 (67.5) | 58 (51.8) |
| Acute Subarachnoid hemorrhage present on CT (%) | 26 (68.4) | 137 (59.8) | 79 (67.5) | 58 (51.8) |
| ICU admission/treatments | ||||
| ICU admission reason (%) | ||||
| Mechanical ventilation | 20 (52.6) | 121 (54.8) | 67 (60.4) | 54 (49.1) |
| Frequent neurological observations | 5 (13.2) | 38 (17.2) | 13 (11.7) | 25 (22.7) |
| Hemodynamic invasive monitoring | 1 (2.6) | 8 (3.6) | 4 (3.6) | 4 (3.6) |
| Extracranial injuries | 1 (2.6) | 4 (1.8) | 3 (2.7) | 1 (0.9) |
| Neurological operation | 9 (23.7) | 22 (10) | 9 (8.1) | 13 (11.8) |
| Clinical deterioration | 2 (5.3) | 28 (12.7) | 15 (13.8) | 12 (11.5) |
| Hemodynamic stability upon ICU admission (%) | 27 (71.1) | 139 (61.2) | 62 (53.0) | 77 (70) |
| Intubated upon ICU admission (%) | 34 (89.5) | 218 (95.2) | 112 (95.7) | 106 (94.6) |
| Mechanically ventilated upon ICU admission (%) | 34 (89.5) | 209 (91.7) | 106 (91.4) | 103 (92) |
| ICP monitor present (%) | 21 (55.3) | 132 (57.6) | 44 (37.6) | 88 (78.6) |
| Intubated during hospital stay (%) | 37 (97.4) | 214 (94.3) | 107 (91.5) | 107 (97.3) |
| Tracheostomy during hospital stay (%) | 10 (26.3) | 16 (7) | 3 (2.6) | 13 (11.8) |
| Oxygen administration during hospital stay (%) | 32 (84.2) | 146 (67.9) | 72 (64.3) | 74 (71.8) |
| Intracranial surgery during hospital stay (%) | 20 (52.6) | 105 (45.9) | 40 (34.2) | 65 (58) |
| Extracranial surgery during hospital stay (%) | 4 (10.5) | 39 (17) | 14 (12) | 25 (22.3) |
| ICP control | ||||
| Metabolic suppression for ICP control (with high dose barbiturates or propofol) (%) | 12 (38.7) | 64 (30.6) | 18 (17.8) | 46 (42.6) |
| Neuromuscular blockade (paralysis) (%) | 7 (22.6) | 60 (28.7) | 23 (22.8) | 37 (34.3) |
| Intensive hypocapnia for ICP control [PaCO2 < 4.0 kPa (30 mmHg)] (%) | 6 (19.4) | 16 (7.7) | 6 (5.9) | 10 (9.3) |
| Hypothermia below 35 °C (%) | 4 (12.9) | 38 (18.2) | 18 (17.8) | 20 (18.5) |
| Decompressive craniectomy | 4 (12.9) | 39 (18.7) | 16 (15.8) | 23 (21.3) |
| Maximum TIL during ICU stay (median [IQR]) | 6.50 [2.25, 11.75] | 8.00 [3.00, 13.25] | 5.00 [1.00, 11.00] | 10.00 [6.50, 15.00] |
| Outcomes | ||||
| Decision maker of WLSM | ||||
| Multidisciplinary | NA | 156 (83) | 81 (81.8) | 75 (84.3) |
| By a single physician | NA | 1 (0.5) | 1 (1) | 0 (0) |
| With a relative | NA | 31 (16.5) | 17 (17.2) | 14 (15.7) |
| Length of hospital stay in days (median [IQR]) | 6.47 [2.53, 12.94] | 3.14 [1.12, 8.84] | 1.13 [0.56, 1.87] | 8.88 [5.36, 14.32] |
| Time in hours between injury and WLSM (median [IQR]) | NA | 68.55 [23.25, 213.00] | 23.60 [12.07, 36.55] | 213.81 [119.38, 344.37] |
| Time in hours between WLSM and death (median [IQR]) | NA | 0.33 [0.00, 6.20] | 0.33 [0.00, 7.00] | 0.29 [0.00, 4.60] |
| IMPACT core probability of mortality 80% or higher (%) | 3 (9.1) | 19 (9.1) | 13 (11.8) | 6 (6.1) |
| IMPACT core probability of unfavorable outcome 80% or higher (%) | 13 (39.4) | 95 (45.5) | 66 (60) | 29 (29.3) |
ASAPS American Society of Anesthesiologists Physical Status; CI confidence interval; CT computed tomography; GCS Glasgow Coma Scale; ICP intracranial pressure; ICU intensive care unit; IMPACT International Mission for Prognosis and Analysis of Clinical Trials in TBI; ISS injury severity score; IQR interquartile range; OR odds ratio; WLSM withdrawal of life-sustaining measures