Withdrawal of life-sustaining measures (WLSM) occurs within 72 h in half of the patients. The occurrence of WLSM varies between regions. The timing of WLSM, however, is not influenced by region or center. WLSM within 72 h occurs mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.