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Withdrawal of Life-supporting Treatment in Severe Traumatic Brain Injury
Williamson T, Ryser MD, Ubel PA, Abdelgadir J, Spears CA, Liu B, Komisarow J, Lemmon ME et al.. JAMA surgery, 2020-08-01
Topic: Risk, prevention and care in population studies
Importance There are limited data on which factors affect the critical and complex decision to withdraw life-supporting treatment (LST) in patients with severe traumatic brain injury (sTBI). Objective To determine demographic and clinical factors associated with the decision to withdraw LST in patients with sTBI. Design, setting, and participants This retrospective analysis of inpatient data from more than 825 trauma centers across the US in the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2015 included adult patients with sTBI and documentation of a decision regarding withdrawal of LST (WLST). Data analysis was conducted in September 2019. Main outcomes and measures Factors associated with WLST in sTBI. Results A total of 37931 patients (9817 women [25.9%]) were included in the multivariable analysis; 7864 (20.7%) had WLST. Black patients (4806 [13.2%]; odds ratio [OR], 0.66; 95% CI, 0.59-0.72; P Conclusions and relevance Withdrawal of LST is common in sTBI and socioeconomic factors are associated with the decision to withdraw LST. These results highlight the many factors that contribute to decision-making in sTBI and demonstrate that in a complex and variable disease process, variation based on race, payment, and region presents as a potential challenge.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Williamson, T., Ryser, M. D., Ubel, P. A., Abdelgadir, J., Spears, C. A., Liu, B., et al. (2020). Withdrawal of Life-supporting Treatment in Severe Traumatic Brain Injury. JAMA surgery. https://doi.org/10.1001/jamasurg.2020.1790
Vancouver
Williamson T, Ryser MD, Ubel PA, Abdelgadir J, Spears CA, Liu B, et al. Withdrawal of Life-supporting Treatment in Severe Traumatic Brain Injury. JAMA surgery. 2020. doi:10.1001/jamasurg.2020.1790. PMID: 32584926.
BibTeX
@article{williamson2020-32584926,
author = {Williamson, T. and Ryser, M. D. and Ubel, P. A. and Abdelgadir, J. and Spears, C. A. and Liu, B. and Komisarow, J. and Lemmon, M. E. and others},
title = {{Withdrawal of Life-supporting Treatment in Severe Traumatic Brain Injury}},
journal = {JAMA surgery},
year = {2020},
doi = {10.1001/jamasurg.2020.1790},
pmid = {32584926},
url = {https://doi.org/10.1001/jamasurg.2020.1790}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- Objective To determine demographic and clinical factors associated with the decision to withdraw LST in patients with sTBI.
- Main outcomes and measures Factors associated with WLST in sTBI.
- Results A total of 37931 patients (9817 women [25.9%]) were included in the multivariable analysis; 7864 (20.7%) had WLST.
- Black patients (4806 [13.2%]; odds ratio [OR], 0.66; 95% CI, 0.59-0.72; P Conclusions and relevance Withdrawal of LST is common in sTBI and socioeconomic factors are associated with the decision to withdraw LST.
- These results highlight the many factors that contribute to decision-making in sTBI and demonstrate that in a complex and variable disease process, variation based on race, payment, and region presents as a potential challenge.
Why it matters
In this large database study of severe traumatic brain injury, withdrawal of life-supporting treatment was common and was associated with socioeconomic factors including race, payment and region. It concerns decision-making in traumatic brain injury and does not test any treatment, cure or prevention for Alzheimer's disease.
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Study details
- Participants37,931
- Effect size25.9%; 20.7%; 13.2%
- Evidence strengthLow
How this study scored 55/100
Published in a peer-reviewed journal. Scored zero for study design and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JAMA surgery) |
| Journal's citation record | 2 / 4 | JAMA Surgery: journal h-index 185 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 4 / 4 | 37,931 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 129 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 16.1 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 4 / 6 | Cited 8.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 3 / 4 | Cited 79 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Shivanand Pramod Lad: h-index 56 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Duke University: institution h-index 1,541 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | PubMed indexes it as a multicentre study |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32584926) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 55 / 100 | — |
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