After Brain Injuries, Doctors and Families Should Take More Time With Life Support Decisions, Research Finds

A small study suggests some severe traumatic brain injury patients can later recover a level of independence or return to their pre-injury lives

Close-up of person in hospital bed holding hands, with nurses blurred in the background
Within 72 hours of a patient being admitted with a severe traumatic brain injury, doctors often ask family members to make a difficult choice about whether to continue life support. Sturti / Getty Images

When a patient suffers a severe traumatic brain injury, their loved ones often face a difficult choice: Wait and see if the person can make a recovery, or withdraw life support measures. In many hospitals, doctors ask family members to make this decision within 72 hours of the patient’s admission.

But according to new research published last week in the Journal of Neurotrauma, family members and health care providers may want to consider taking a slower, more cautious approach to withdrawing life support. The study finds that, when kept on life support, some traumatic brain injury patients may heal enough to regain at least partial independence. Some might even be able to resume their pre-injury lives.

Globally, between 27 million and 69 million people suffer traumatic brain injuries each year, with about 5.5 million annual cases classified as severe. These can occur for numerous reasons, including falls, car accidents, sports injuries, explosions, gunshot wounds and other violence. Often, traumatic brain injury patients end up in a coma or a minimally conscious state immediately after the accident.

Many people never recover from traumatic brain injuries, while others may end up with permanent disabilities. This uncertain prognosis, balanced with the desire to not prolong a patient’s suffering, makes it challenging for doctors and family members to know when—and if—they should withdraw life support. The difficulty is compounded by a lack of data about the long-term fate of patients with traumatic brain injuries.

“Physicians are in an extremely difficult situation,” says study co-author Yelena Bodien, a neuroscientist at Massachusetts General Hospital and Spaulding Rehabilitation Hospital, to the New York Times’ Gina Kolata. “Patients are on the cusp of life or death with incredibly devastating injuries. Physicians are under an immense amount of pressure to provide families with a precise diagnosis.”

To better understand the issue, researchers studied a database of 1,392 severe traumatic brain injury patients in intensive care units at 18 trauma centers in the United States, tracked over a seven-and-a-half-year period. They created a mathematical model based on the patients’ injuries, demographics and socioeconomic factors.

Then, the team used the model to compare 160 similar patients for whom life support was either withdrawn or continued. Their analysis found that many patients who had life support withdrawn would have likely died anyway. But 42 percent of those who continued on life support and survived ended up regaining some independence up to 12 months after injury.

The findings suggest a “cyclical, self-fulfilling prophecy” may be at play in trauma centers, according to a statement from Mass General Brigham. Doctors assume that patients with traumatic brain injuries will not recover or will fare poorly, which leads to the withdrawal of life support. This, in turn, results in patients’ deaths, which prompts even more decisions to withdraw life support, according to the statement.

Ariane Lewis, a neurologist and neurosurgeon at NYU Langone Medical Center who was not involved with the research, echoed that sentiment. She tells United Press International’s (UPI) Susan Kreimer that “our understanding of recovery after acute brain injury has been jaded by nihilism and the self-fulfilling prophecy.”

Still, the researchers urged caution in interpreting the results. They’re not meant to be applied to individual cases, reports STAT ’s Annalisa Merelli. In addition, the scientists are not advocating for continuing life support for all traumatic brain injury patients. Those decisions are “multifaceted” and highly personal—often, they hinge on whether the level of recovery is “something that the patient would have been happy with,” says Damian Cruse, a psychologist at the University of Birmingham in England who was not involved in the research, to New Scientist’s Moheb Costandi.

Rather, the findings suggest that health care providers and family members should take a little more time before making any life support decisions. The extra time may also allow family members to make a more clear-headed decision, after they’ve recovered somewhat from the initial shock of the patient’s injury.

“We can’t predict based on the first few days after an injury what’s going to happen very well,” says James Sulzer, a physical medicine and rehabilitation researcher at Case Western Reserve University who was not involved in the research, to STAT. “We don’t know enough about how damage to the brain affects function. We don’t know enough about how damage to the brain affects recovery.”

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