Race and Socio-Economic Status Impact Withdrawal of Treatment in Young Traumatic Brain Injury.

CONTEXT: Withdrawal of life-sustaining therapies (WDLST) in young individuals with traumatic brain injury (TBI) is an overwhelming situation often made more stressful by socioeconomic factors that shape health outcomes. Identifying these factors is crucial to developing equitable and goal-concordant care for patients and families.

OBJECTIVES: We aimed to identify predictors of WDLST in young patients with TBI. We hypothesized uninsured payment method, race, and co-morbid status are associated with WDLST.

METHODS: We queried the 2021 Trauma Quality Improvement Program database for patients <45 years with TBI. Patients with WDLST were compared to patients without WDLST. Multivariable logistic regression (MLR) was performed.

RESULTS: 61,115 patients were included, of whom 2,487 (4.1%) underwent WDLST. Patients in the WDLST cohort were older (29 vs 27,p<0.001), more likely to suffer from a penetrating mechanism (29% vs 11%,p<.0001), and have uninsured (22% vs 18%) or other payment method (5% vs 3%) when compared to the non-WDLST cohort. MLR identified age (AOR:1.019, 95%CI 1.014-1.024, p<.0001), non-Hispanic ethnicity (AOR:1.590, 95%CI 1.373-1.841,p<.0001), penetrating mechanism (AOR:3.075, 95%CI 2.727-3.467,p<.0001), systolic blood pressure (AOR: 0.992, 95%CI 0.990-0.993,p<0.0001), advanced directive (AOR:4.987, 95%CI 2.823-8.812,p<.0001), cirrhosis (AOR:3.854, 95%CI 2.641-5.625,p<.0001), disseminated cancer (AOR:6.595, 95%CI 2.370-18.357,p=0.0003), and interfacility transfer (AOR:1.457, 95%CI 1.295-1.640,p<0.0001) as factors associated with WDLST. Black patients were less likely to undergo WDLST when compared to white patients (AOR:0.687, 95%CI 0.603-0.782,p<.0001).

CONCLUSION: The decision for WDLST in young patients with severe TBI may be influenced by cultural and socioeconomic factors in addition to clinical considerations.