Study details

For the study, researchers looked at data from a national database including nearly 1,400 TBI patients. They compared 80 patients with severe injuries who died after life support was withdrawn and 80 similar patients whose life support was not withdrawn.

The researchers found that the majority of patients whose life support wasn't withdrawn ended up dying in the hospital anyways within about six days. However, 42% of patients who continued life support recovered enough within the following year to have some level of independence, and a few even returned to their former lives.

Typically, doctors have a conversation with a patient's family about life support within 72 hours of the patient's admission to the hospital. But the researchers said their limited data suggests that doctors' predictions are frequently incorrect so soon after an injury, meaning more time and more data could be beneficial.

Discussion

Yelena Bodien, an assistant professor of neurology at Massachusetts General Hospital and corresponding author on the study, said that while an injury "can look quite devastating hours or a few days after it happens, in many cases we have some evidence to suggest that even with the most devastating injuries people may make a recovery that is meaningful to them months or years later."

However, Bodien cautioned that the study's results shouldn't be applied to individual cases and that it's not suggesting that life support should always be continued.

"What we don't want is to see families prolong suffering, because they're worried that they're missing something," said Theresa Williamson, a coauthor on the study and an assistant professor of neurosurgery at Massachusetts General Hospital. "I can imagine if I was a family member reading this, I might think, 'Oh my goodness, did I do something wrong? Did I miss it?' And I think the answer is, probably not."

Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, said that despite the limitations of the study, "this data is really helpful."

Koroshetz said that doctors know recovery is slow and typically takes months or years. However, he added that some patients who needed ventilators and were expected to be very disabled afterwards walk into the hospital a year later "chatting it up with the nurses."

"That's the problem," he said. "People can make a good recovery."

Claude Hemphill, from the University of California, San Francisco, said there's nothing scientific about making a decision within 72 hours. That time frame is a convention because "these people look very sick when they come in," he said. As a result, "many physicians have felt compelled to make a decision early."

Bodien said the study results call for better cooperation between critical care doctors and rehabilitation professionals.

"Critical care physicians, they do not have the opportunity to follow their patients long term," she said. "They see a very sick patient with a devastating injury, and they can’t even imagine what it might look like over the long term."

However, Bodien acknowledged that rehab doctors may not be as well-versed in understanding how severe an injury is as critical care doctors.

"[We] need to work together across disciplines to really understand the long term trajectory of recovery," she said. (Kolata, New York Times, 5/17; Merelli, STAT, 5/14)

How and where Americans die has drastically changed over time. Until the 20th century sudden death was the most common way to die, and home the most common place. Explore our infographic to learn about  the impact of end-of-life care on quality and costs, the difference between hospice and palliative care, and patient control over end-of-life decisions.