Tuesday, February 21, 2006

Withdrawal of life-prolonging care in trauma patients; Malawi

An interesting article from the surgical literature...

The Journal of Trauma has published a piece looking at which trauma patients get life-prolonging care withdrawn.  It looks at 64 older patients (over 55 years old) at a single trauma center who died in a 3 year period, and compares those who had life-sustaining treatment withdrawn to those who didn't.  55% of this group died after withdrawal of life-sustaining care--none of these were brain dead.  The only factor which predicted (with statistical significance) withdrawal was having a family meeting, although having an advance directive trended towards signficantly predicting withdawal (the study was probably underpowered to detect this with only 64 patients).  Interestingly neither age, prognosis (based on Glasgow coma score & other trauma prognostic indices), or comorbidity predicted withdrawal.  This strongly suggests that decisions in this unit were made based mostly on patient/family preferences/values and not on prognosis or likelihood of meaningful recovery.

Persuant to a recent Pallimed comments discussion, BMC Palliative Care has just published an article about symptoms in a very ill HIV-AIDS home-care cohort in Malawi.  (All BMC PC articles are available in free full-text online). 

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