doi: 10.1016/j.jocn.2025.111191.
Epub 2025 Mar 18.
Predictors of withdrawal of life-sustaining therapies in older adults with TBI and a modified frailty index score
Collaborators,
Affiliations
Collaborators
-
American Association for the Surgery of Trauma GERI-TBI Study Group:
Mira Ghneim 6 , Jennifer S Albrecht 7 , Karen Brasel 8 , Anna Livaris 9 , Jill B Watras 10 , Christopher P Michetti 11 , James M Haan 12 , Kelly Lightwine 13 , Robert D Winfield 14 , Sasha D Adams 15 , Jeanette M Podbielski 16 , Scott B Armen 17 , J Christopher Zacko 18 , Fady S Nasrallah 19 , Kathryn B Schaffer 20 , Julie Dunn 21 , Lars Widdel 22 , Thomas J Schroeppel 23 , Zachery Stillman 24 , Zara Cooper 25 , Deborah Stein 26 , Charles Adams 27 , Stephanie Lueckel 28 , Jason Murry 29 , Nikita Patel 30 , Cindy Hsu 31 , Umer F Bhatti 32 , Matthew E Lissauer 33 , Marc LaFonte 34 , Kaveh Najafi 35 , Karen Lewandowski 36 , Kaushik Mukherjee 37 , Kristelle E Imperio-Lagabon 37 , Niels D Martin 38 , Kathleen Hirsch 39 , Cherisse Berry 40 , Derek Freitas 41 , Daniel Cullinane 42 , Roshini Ramawi 43 , Michael Truitt 44 , Chris Pearcy 45 , Habiba Hashimi 46 , Krista Kaups 47 , Jeffry Claridge 48 , Husayn Ladhani 49 , Jennifer L Hartwell 50 , Jessica Ballou 51 , Martin Croce 52 , Stephanie Markle 53 , Sally Osserwaarde 54 , Joseph Posluszny 55 , Benjamin Stocker 56 , Tjasa Hranjec 57 , Rachele Solomon 58 , Lucy Martinek 59 , Alok Gupta 60 , Daniel J Grabo 61 , Uzer Khan 62 , Danielle Tatum 63 , Tomas Jacome 64 , Jonathan Gates 65 , Alisha Jawani 66 , Allison E Berndtson 67 , Terry G Curry 68 , Miklosh Bala 69 , Linda A Dultz 70 , Natasha N Houshmand 71 , Paola Pieri 72 , Martin D Zielinski 73 , Joy D Hughes 74 , Jennifer Hartwell 75 , Ajai K Malhotra 76 , Tim Lee 77 , Patrizio Petrone 78 , D'andrea Joseph 79 , Gary T Marshall 80 , Matthew M Carrick 81 , Abhijit Pathak 82 , Andrea Van Zandt 83 , Nina Glass 84 , David Livingston 85 , Shea Gregg 86 , Travis Webb 87 , Byron Drumheller 88 , Rosemary Kozar 89 , Robert Barraco 90 , Bellal Joseph 91
Affiliations
- 1 Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 2 Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
- 3 Division of Trauma and Acute Care Surgery, Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 4 Department of Physical Medicine and Rehabilitation, Population Health Research Institute, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 5 Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: mkelly4@metrohealth.org.
- 6 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: mira.ghneim@som.umaryland.edu.
- 7 Department of Epidemiology and Public Health, The University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA. Electronic address: jalbrecht@som.umaryland.edu.
- 8 Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: brasel@ohsu.edu.
- 9 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: aliveris@gmail.com.
- 10 Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA 22042, USA. Electronic address: jill.watras@inova.org.
- 11 Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA 22042, USA. Electronic address: christopher.michetti@inova.org.
- 12 Ascension Via Christi Hospital, 929 North Saint Francis Wichita, KS 67214, USA. Electronic address: James.Haan@ascension.org.
- 13 Ascension Via Christi Hospital, 929 North Saint Francis Wichita, KS 67214, USA. Electronic address: Kelly.Lightwine@ascension.org.
- 14 University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address: rwinfield@kumc.edu.
- 15 University of Texas Health Science Center at Houston, 7000 Fannin St #1200, Houston, TX 77030, USA. Electronic address: sasha.d.adams@uth.tmc.edu.
- 16 University of Texas Health Science Center at Houston, 7000 Fannin St #1200, Houston, TX 77030, USA. Electronic address: Jeanette.m.podbielski@uth.tmc.edu.
- 17 Penn State Health System, 500 University Dr, Hershey, PA 17033, USA. Electronic address: sarmen@pennstatehealth.psu.edu.
- 18 Penn State Health System, 500 University Dr, Hershey, PA 17033, USA. Electronic address: jzacko@pennstatehealth.psu.edu.
- 19 Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA 92037, USA. Electronic address: Nasrallah.Fady@Scrippshealth.org.
- 20 Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA 92037, USA. Electronic address: Schaffer.Kathryn@Scrippshealth.org.
- 21 Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA. Electronic address: Julie.Dunn@uchealth.org.
- 22 Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA. Electronic address: Lars.Widdel@uchealth.org.
- 23 UC Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, USA. Electronic address: Thomas.Schroeppel@uchealth.org.
- 24 UC Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, USA. Electronic address: Zachery.stillman@uchealth.org.
- 25 Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. Electronic address: zcooper@bwh.harvard.edu.
- 26 Univeristy of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: deborah.stein@ucsf.edu.
- 27 Rhode Island Hospital, 80 Dudley St, Providence, RI 02905, USA. Electronic address: CAdams1@lifespan.org.
- 28 Rhode Island Hospital, 80 Dudley St, Providence, RI 02905, USA. Electronic address: slueckel@lifespan.org.
- 29 University of Texas Health Science Center at Tyler, 11937 US-271, Tyler, TX 75708, USA. Electronic address: jason.murry@gmail.com.
- 30 University of Texas Health Science Center at Tyler, 11937 US-271, Tyler, TX 75708, USA. Electronic address: NPATEL46@mgh.harvard.edu.
- 31 University of Michigan, 500 S State St, Ann Arbor, MI 48109, USA. Electronic address: hcindy@med.umich.edu.
- 32 University of Michigan, 500 S State St, Ann Arbor, MI 48109, USA. Electronic address: ufb@med.umich.edu.
- 33 Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building (CAB), 125 Paterson St, New Brunswick, NJ 08901, USA. Electronic address: ML1141@RWJMS.Rutgers.edu.
- 34 Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building (CAB), 125 Paterson St, New Brunswick, NJ 08901, USA. Electronic address: ML1371@RWJMS.Rutgers.edu.
- 35 Honor Health Scottdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ 85251, USA. Electronic address: Kaveh.najafi@honorhealth.com.
- 36 Honor Health Scottdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ 85251, USA. Electronic address: Karen.lewandowski@honorhealth.com.
- 37 Loma Linda University Medical Center, 11290 Campus St., Suite 200, Loma Linda, CA 92354, USA. Electronic address: kmukherjee@llu.edu.
- 38 University of Pennsylvania, 3400 Civic Center Boulevard West Pavilion, 2nd Floor & 4th Floor, Philadelphia, PA 19104, USA. Electronic address: niels.martin@uphs.upenn.edu.
- 39 University of Pennsylvania, 3400 Civic Center Boulevard West Pavilion, 2nd Floor & 4th Floor, Philadelphia, PA 19104, USA. Electronic address: Kathleen.Hirsch@uphs.upenn.edu.
- 40 New York University/Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016, USA. Electronic address: Cherisse.Berry@nyulangone.org.
- 41 New York University/Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016, USA. Electronic address: Derek.Freitas@nyulangone.org.
- 42 Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA. Electronic address: cullinane.daniel@marshfieldclinic.org.
- 43 Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA. Electronic address: Ramwani.roshini@marshfieldclinic.org.
- 44 Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX 75203, USA. Electronic address: mike_truitt@hotmail.com.
- 45 Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX 75203, USA. Electronic address: ChrisPearcy@mhd.com.
- 46 University of California San Francisco Fresno, 155 N Fresno St, Fresno, CA 93701, USA. Electronic address: hhashimi@fresno.ucsf.edu.
- 47 University of California San Francisco Fresno, 155 N Fresno St, Fresno, CA 93701, USA. Electronic address: kkaupsmd@communitymedical.org.
- 48 MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, USA. Electronic address: jclaridge@metrohealth.org.
- 49 MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, USA. Electronic address: husaynladhani@gmail.com.
- 50 Indiana University Health Methodist, 1701 N Senate Ave, Indianapolis, IN 46202, USA; Indiana University at Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA. Electronic address: jhartwell@iuhealth.org.
- 51 Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: ballouj@ohsu.edu.
- 52 University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN 38163, USA. Electronic address: mcroce@uthsc.edu.
- 53 Ascension Borgess, 1521 Gull Rd, Kalamazoo, MI 49048, USA. Electronic address: Stephanie.markle@ascension.org.
- 54 Ascension Borgess, 1521 Gull Rd, Kalamazoo, MI 49048, USA. Electronic address: Sally.ossewaarde@ascension.org.
- 55 Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: joseph.posluszny@nm.org.
- 56 Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: benjamin.stocker@northwestern.edu.
- 57 Memorial Regional Hospital, 1150 N 35th Ave Suite 600, Hollywood, FL 33021, USA. Electronic address: thranjec@mhs.net.
- 58 Memorial Regional Hospital, 1150 N 35th Ave Suite 600, Hollywood, FL 33021, USA. Electronic address: Rasolomon@mhs.net.
- 59 Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. Electronic address: lcmartin@bidmc.harvard.edu.
- 60 Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. Electronic address: agupta4@bidmc.harvard.edu.
- 61 West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506, USA. Electronic address: daniel.grabo@hsc.wvu.edu.
- 62 West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506, USA. Electronic address: ukhan@hsc.wvu.edu.
- 63 Our Lady of the Lake Regional Medical Center, 5000 Hennessy Blvd, Baton Rouge, LA 70808, USA. Electronic address: Danielle.Tatum@fmolhs.org.
- 64 Our Lady of the Lake Regional Medical Center, 5000 Hennessy Blvd, Baton Rouge, LA 70808, USA. Electronic address: Tomas.Jacome@fmolhs.org.
- 65 Hartford Hospital, 80 Seymour St, Hartford, CT 06106, USA. Electronic address: Jonathan.Gates@hhchealth.org.
- 66 Hartford Hospital, 80 Seymour St, Hartford, CT 06106, USA. Electronic address: alisha.z.jawani@gmail.com.
- 67 University of California San Diego Medical Center, 9500 Gilman Drive La Jolla, CA 92093, USA. Electronic address: aberndtson@ucsd.edu.
- 68 University of California San Diego Medical Center, 9500 Gilman Drive La Jolla, CA 92093, USA. Electronic address: tcurry@ucsd.edu.
- 69 Hadassah Hebrew University Medical Center, Sderot Churchill 8, Jerusalem, Israel. Electronic address: rbalam@hadassah.org.il.
- 70 The University of Texas Southwestern Medical Center, Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235, USA. Electronic address: linda.dultz@utsouthwestern.edu.
- 71 The University of Texas Southwestern Medical Center, Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235, USA. Electronic address: natasha.houshmand@utsouthwestern.edu.
- 72 Maricopa Intergrated Health Systems, 2601 E Roosevelt St, Phoenix, AZ 85008, USA. Electronic address: paolapieri@hotmail.com.
- 73 Mayo Clinic Rochester, 201 W Center St, Rochester, MN 55902, USA. Electronic address: Zielinski.martin@mayo.edu.
- 74 Mayo Clinic Rochester, 201 W Center St, Rochester, MN 55902, USA. Electronic address: Hughes.joy@mayo.edu.
- 75 Indiana University at Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA. Electronic address: hartwell.jennifer@gmail.com.
- 76 University of Vermont, Burlington, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address: Ajai.Malhotra@uvmhealth.org.
- 77 University of Vermont, Burlington, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address: Tim.Lee@uvmhealth.org.
- 78 New York University Winthrop Hospital, 259 1st St, Mineola, NY 11501, USA. Electronic address: ppetrone@NYUWinthrop.org.
- 79 New York University Winthrop Hospital, 259 1st St, Mineola, NY 11501, USA. Electronic address: djoseph1@nyuwinthrop.org.
- 80 Medical Center of Plano, 3901 W 15th St, Plano, TX 75075, USA. Electronic address: gary.marshall@emcare.com.
- 81 Medical Center of Plano, 3901 W 15th St, Plano, TX 75075, USA. Electronic address: matt.carrick@acutesurgical.com.
- 82 Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA. Electronic address: Abhijit.Pathak@tuhs.temple.edu.
- 83 Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA. Electronic address: Andrea.vanzandt@tuhs.temple.edu.
- 84 Rutgers Medical School University Hospital, 150 Bergen St, Newark, NJ 07103, USA. Electronic address: Nina.Glass@rutgers.edu.
- 85 Rutgers Medical School University Hospital, 150 Bergen St, Newark, NJ 07103, USA. Electronic address: livingst@njms.rutgers.edu.
- 86 Bridgeport hospital, 267 Grant St, Bridgeport, CT 06610, USA. Electronic address: striamed1@gmail.com.
- 87 Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, USA. Electronic address: trwebb@mcw.edu.
- 88 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: Byron.drumheller@gmail.com.
- 89 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: rkozar@som.umaryland.edu.
- 90 The University of Arizona, 3838 N Campbell Ave #2, Tucson, AZ 85719, USA. Electronic address: robert_d.barraco@lvhn.org.
- 91 University of San Francisco - Lehigh Valley, 1247 S Cedar Crest Blvd. Suite 202, Allentown PA 18103-6298, USA. Electronic address: bjoseph@surgery.arizona.edu.
- PMID: 40107005
- DOI: 10.1016/j.jocn.2025.111191
Item in Clipboard
Predictors of withdrawal of life-sustaining therapies in older adults with TBI and a modified frailty index score
John J Francis et al.
J Clin Neurosci.
2025 May.
Display options
Format
doi: 10.1016/j.jocn.2025.111191.
Epub 2025 Mar 18.
Authors
Collaborators
-
American Association for the Surgery of Trauma GERI-TBI Study Group:
Mira Ghneim 6 , Jennifer S Albrecht 7 , Karen Brasel 8 , Anna Livaris 9 , Jill B Watras 10 , Christopher P Michetti 11 , James M Haan 12 , Kelly Lightwine 13 , Robert D Winfield 14 , Sasha D Adams 15 , Jeanette M Podbielski 16 , Scott B Armen 17 , J Christopher Zacko 18 , Fady S Nasrallah 19 , Kathryn B Schaffer 20 , Julie Dunn 21 , Lars Widdel 22 , Thomas J Schroeppel 23 , Zachery Stillman 24 , Zara Cooper 25 , Deborah Stein 26 , Charles Adams 27 , Stephanie Lueckel 28 , Jason Murry 29 , Nikita Patel 30 , Cindy Hsu 31 , Umer F Bhatti 32 , Matthew E Lissauer 33 , Marc LaFonte 34 , Kaveh Najafi 35 , Karen Lewandowski 36 , Kaushik Mukherjee 37 , Kristelle E Imperio-Lagabon 37 , Niels D Martin 38 , Kathleen Hirsch 39 , Cherisse Berry 40 , Derek Freitas 41 , Daniel Cullinane 42 , Roshini Ramawi 43 , Michael Truitt 44 , Chris Pearcy 45 , Habiba Hashimi 46 , Krista Kaups 47 , Jeffry Claridge 48 , Husayn Ladhani 49 , Jennifer L Hartwell 50 , Jessica Ballou 51 , Martin Croce 52 , Stephanie Markle 53 , Sally Osserwaarde 54 , Joseph Posluszny 55 , Benjamin Stocker 56 , Tjasa Hranjec 57 , Rachele Solomon 58 , Lucy Martinek 59 , Alok Gupta 60 , Daniel J Grabo 61 , Uzer Khan 62 , Danielle Tatum 63 , Tomas Jacome 64 , Jonathan Gates 65 , Alisha Jawani 66 , Allison E Berndtson 67 , Terry G Curry 68 , Miklosh Bala 69 , Linda A Dultz 70 , Natasha N Houshmand 71 , Paola Pieri 72 , Martin D Zielinski 73 , Joy D Hughes 74 , Jennifer Hartwell 75 , Ajai K Malhotra 76 , Tim Lee 77 , Patrizio Petrone 78 , D'andrea Joseph 79 , Gary T Marshall 80 , Matthew M Carrick 81 , Abhijit Pathak 82 , Andrea Van Zandt 83 , Nina Glass 84 , David Livingston 85 , Shea Gregg 86 , Travis Webb 87 , Byron Drumheller 88 , Rosemary Kozar 89 , Robert Barraco 90 , Bellal Joseph 91
Affiliations
- 1 Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 2 Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
- 3 Division of Trauma and Acute Care Surgery, Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 4 Department of Physical Medicine and Rehabilitation, Population Health Research Institute, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
- 5 Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA. Electronic address: mkelly4@metrohealth.org.
- 6 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: mira.ghneim@som.umaryland.edu.
- 7 Department of Epidemiology and Public Health, The University of Maryland School of Medicine, 655 W Baltimore Street, Baltimore, MD 21201, USA. Electronic address: jalbrecht@som.umaryland.edu.
- 8 Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: brasel@ohsu.edu.
- 9 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: aliveris@gmail.com.
- 10 Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA 22042, USA. Electronic address: jill.watras@inova.org.
- 11 Inova Fairfax Medical Campus, 3300 Gallows Rd, Falls Church, VA 22042, USA. Electronic address: christopher.michetti@inova.org.
- 12 Ascension Via Christi Hospital, 929 North Saint Francis Wichita, KS 67214, USA. Electronic address: James.Haan@ascension.org.
- 13 Ascension Via Christi Hospital, 929 North Saint Francis Wichita, KS 67214, USA. Electronic address: Kelly.Lightwine@ascension.org.
- 14 University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address: rwinfield@kumc.edu.
- 15 University of Texas Health Science Center at Houston, 7000 Fannin St #1200, Houston, TX 77030, USA. Electronic address: sasha.d.adams@uth.tmc.edu.
- 16 University of Texas Health Science Center at Houston, 7000 Fannin St #1200, Houston, TX 77030, USA. Electronic address: Jeanette.m.podbielski@uth.tmc.edu.
- 17 Penn State Health System, 500 University Dr, Hershey, PA 17033, USA. Electronic address: sarmen@pennstatehealth.psu.edu.
- 18 Penn State Health System, 500 University Dr, Hershey, PA 17033, USA. Electronic address: jzacko@pennstatehealth.psu.edu.
- 19 Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA 92037, USA. Electronic address: Nasrallah.Fady@Scrippshealth.org.
- 20 Scripps Memorial Hospital La Jolla, 9888 Genesee Ave, La Jolla, CA 92037, USA. Electronic address: Schaffer.Kathryn@Scrippshealth.org.
- 21 Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA. Electronic address: Julie.Dunn@uchealth.org.
- 22 Medical Center of the Rockies, 2500 Rocky Mountain Ave, Loveland, CO 80538, USA. Electronic address: Lars.Widdel@uchealth.org.
- 23 UC Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, USA. Electronic address: Thomas.Schroeppel@uchealth.org.
- 24 UC Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO 80909, USA. Electronic address: Zachery.stillman@uchealth.org.
- 25 Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. Electronic address: zcooper@bwh.harvard.edu.
- 26 Univeristy of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: deborah.stein@ucsf.edu.
- 27 Rhode Island Hospital, 80 Dudley St, Providence, RI 02905, USA. Electronic address: CAdams1@lifespan.org.
- 28 Rhode Island Hospital, 80 Dudley St, Providence, RI 02905, USA. Electronic address: slueckel@lifespan.org.
- 29 University of Texas Health Science Center at Tyler, 11937 US-271, Tyler, TX 75708, USA. Electronic address: jason.murry@gmail.com.
- 30 University of Texas Health Science Center at Tyler, 11937 US-271, Tyler, TX 75708, USA. Electronic address: NPATEL46@mgh.harvard.edu.
- 31 University of Michigan, 500 S State St, Ann Arbor, MI 48109, USA. Electronic address: hcindy@med.umich.edu.
- 32 University of Michigan, 500 S State St, Ann Arbor, MI 48109, USA. Electronic address: ufb@med.umich.edu.
- 33 Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building (CAB), 125 Paterson St, New Brunswick, NJ 08901, USA. Electronic address: ML1141@RWJMS.Rutgers.edu.
- 34 Rutgers-Robert Wood Johnson Medical School, Clinical Academic Building (CAB), 125 Paterson St, New Brunswick, NJ 08901, USA. Electronic address: ML1371@RWJMS.Rutgers.edu.
- 35 Honor Health Scottdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ 85251, USA. Electronic address: Kaveh.najafi@honorhealth.com.
- 36 Honor Health Scottdale Osborn Medical Center, 7400 E Osborn Rd, Scottsdale, AZ 85251, USA. Electronic address: Karen.lewandowski@honorhealth.com.
- 37 Loma Linda University Medical Center, 11290 Campus St., Suite 200, Loma Linda, CA 92354, USA. Electronic address: kmukherjee@llu.edu.
- 38 University of Pennsylvania, 3400 Civic Center Boulevard West Pavilion, 2nd Floor & 4th Floor, Philadelphia, PA 19104, USA. Electronic address: niels.martin@uphs.upenn.edu.
- 39 University of Pennsylvania, 3400 Civic Center Boulevard West Pavilion, 2nd Floor & 4th Floor, Philadelphia, PA 19104, USA. Electronic address: Kathleen.Hirsch@uphs.upenn.edu.
- 40 New York University/Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016, USA. Electronic address: Cherisse.Berry@nyulangone.org.
- 41 New York University/Bellevue Hospital Center, 462 1st Avenue, New York, NY 10016, USA. Electronic address: Derek.Freitas@nyulangone.org.
- 42 Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA. Electronic address: cullinane.daniel@marshfieldclinic.org.
- 43 Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA. Electronic address: Ramwani.roshini@marshfieldclinic.org.
- 44 Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX 75203, USA. Electronic address: mike_truitt@hotmail.com.
- 45 Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX 75203, USA. Electronic address: ChrisPearcy@mhd.com.
- 46 University of California San Francisco Fresno, 155 N Fresno St, Fresno, CA 93701, USA. Electronic address: hhashimi@fresno.ucsf.edu.
- 47 University of California San Francisco Fresno, 155 N Fresno St, Fresno, CA 93701, USA. Electronic address: kkaupsmd@communitymedical.org.
- 48 MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, USA. Electronic address: jclaridge@metrohealth.org.
- 49 MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109, USA. Electronic address: husaynladhani@gmail.com.
- 50 Indiana University Health Methodist, 1701 N Senate Ave, Indianapolis, IN 46202, USA; Indiana University at Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA. Electronic address: jhartwell@iuhealth.org.
- 51 Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Electronic address: ballouj@ohsu.edu.
- 52 University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN 38163, USA. Electronic address: mcroce@uthsc.edu.
- 53 Ascension Borgess, 1521 Gull Rd, Kalamazoo, MI 49048, USA. Electronic address: Stephanie.markle@ascension.org.
- 54 Ascension Borgess, 1521 Gull Rd, Kalamazoo, MI 49048, USA. Electronic address: Sally.ossewaarde@ascension.org.
- 55 Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: joseph.posluszny@nm.org.
- 56 Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA. Electronic address: benjamin.stocker@northwestern.edu.
- 57 Memorial Regional Hospital, 1150 N 35th Ave Suite 600, Hollywood, FL 33021, USA. Electronic address: thranjec@mhs.net.
- 58 Memorial Regional Hospital, 1150 N 35th Ave Suite 600, Hollywood, FL 33021, USA. Electronic address: Rasolomon@mhs.net.
- 59 Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. Electronic address: lcmartin@bidmc.harvard.edu.
- 60 Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. Electronic address: agupta4@bidmc.harvard.edu.
- 61 West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506, USA. Electronic address: daniel.grabo@hsc.wvu.edu.
- 62 West Virginia University, 1 Medical Center Dr, Morgantown, WV 26506, USA. Electronic address: ukhan@hsc.wvu.edu.
- 63 Our Lady of the Lake Regional Medical Center, 5000 Hennessy Blvd, Baton Rouge, LA 70808, USA. Electronic address: Danielle.Tatum@fmolhs.org.
- 64 Our Lady of the Lake Regional Medical Center, 5000 Hennessy Blvd, Baton Rouge, LA 70808, USA. Electronic address: Tomas.Jacome@fmolhs.org.
- 65 Hartford Hospital, 80 Seymour St, Hartford, CT 06106, USA. Electronic address: Jonathan.Gates@hhchealth.org.
- 66 Hartford Hospital, 80 Seymour St, Hartford, CT 06106, USA. Electronic address: alisha.z.jawani@gmail.com.
- 67 University of California San Diego Medical Center, 9500 Gilman Drive La Jolla, CA 92093, USA. Electronic address: aberndtson@ucsd.edu.
- 68 University of California San Diego Medical Center, 9500 Gilman Drive La Jolla, CA 92093, USA. Electronic address: tcurry@ucsd.edu.
- 69 Hadassah Hebrew University Medical Center, Sderot Churchill 8, Jerusalem, Israel. Electronic address: rbalam@hadassah.org.il.
- 70 The University of Texas Southwestern Medical Center, Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235, USA. Electronic address: linda.dultz@utsouthwestern.edu.
- 71 The University of Texas Southwestern Medical Center, Parkland Hospital, 5200 Harry Hines Blvd, Dallas, TX 75235, USA. Electronic address: natasha.houshmand@utsouthwestern.edu.
- 72 Maricopa Intergrated Health Systems, 2601 E Roosevelt St, Phoenix, AZ 85008, USA. Electronic address: paolapieri@hotmail.com.
- 73 Mayo Clinic Rochester, 201 W Center St, Rochester, MN 55902, USA. Electronic address: Zielinski.martin@mayo.edu.
- 74 Mayo Clinic Rochester, 201 W Center St, Rochester, MN 55902, USA. Electronic address: Hughes.joy@mayo.edu.
- 75 Indiana University at Eskenazi Health, 720 Eskenazi Avenue, Indianapolis, IN 46202, USA. Electronic address: hartwell.jennifer@gmail.com.
- 76 University of Vermont, Burlington, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address: Ajai.Malhotra@uvmhealth.org.
- 77 University of Vermont, Burlington, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address: Tim.Lee@uvmhealth.org.
- 78 New York University Winthrop Hospital, 259 1st St, Mineola, NY 11501, USA. Electronic address: ppetrone@NYUWinthrop.org.
- 79 New York University Winthrop Hospital, 259 1st St, Mineola, NY 11501, USA. Electronic address: djoseph1@nyuwinthrop.org.
- 80 Medical Center of Plano, 3901 W 15th St, Plano, TX 75075, USA. Electronic address: gary.marshall@emcare.com.
- 81 Medical Center of Plano, 3901 W 15th St, Plano, TX 75075, USA. Electronic address: matt.carrick@acutesurgical.com.
- 82 Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA. Electronic address: Abhijit.Pathak@tuhs.temple.edu.
- 83 Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA. Electronic address: Andrea.vanzandt@tuhs.temple.edu.
- 84 Rutgers Medical School University Hospital, 150 Bergen St, Newark, NJ 07103, USA. Electronic address: Nina.Glass@rutgers.edu.
- 85 Rutgers Medical School University Hospital, 150 Bergen St, Newark, NJ 07103, USA. Electronic address: livingst@njms.rutgers.edu.
- 86 Bridgeport hospital, 267 Grant St, Bridgeport, CT 06610, USA. Electronic address: striamed1@gmail.com.
- 87 Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, USA. Electronic address: trwebb@mcw.edu.
- 88 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: Byron.drumheller@gmail.com.
- 89 R Adams Cowley Shock Trauma, The University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA. Electronic address: rkozar@som.umaryland.edu.
- 90 The University of Arizona, 3838 N Campbell Ave #2, Tucson, AZ 85719, USA. Electronic address: robert_d.barraco@lvhn.org.
- 91 University of San Francisco - Lehigh Valley, 1247 S Cedar Crest Blvd. Suite 202, Allentown PA 18103-6298, USA. Electronic address: bjoseph@surgery.arizona.edu.
- PMID: 40107005
- DOI: 10.1016/j.jocn.2025.111191
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Abstract
Background: Withdrawal-of-life-sustaining-therapies (WLST) in patients with traumatic brain injury (TBI) is a complex decision-making process. The clinical factors related to WLST in older adults with TBI are currently poorly understood. The present study aims to determine the clinical predictors of WLST in older patients with TBI.
Methods: All patients ≥ 65 years old with TBI (Head Abbreviated Injury Scale Score ≥ 3) were identified from the Geriatric TBI Database, a prospective registry of patients admitted to 45 trauma centers nationwide with TBI between 2017-2019. We collected factors related to past medical history, baseline demographic data, clinical presentation, TBI sub-type, neurosurgical interventions, and do-not-attempt-resuscitation (DNAR) orders. The primary outcome measure was WLST. Binary logistic regression was subsequently performed to determine factors independently associated with WLST.
Results: A total of 1600 patients were identified. The median age was 80 years old and 48.6 % of patients were male. In this cohort, 120 patients (7.5 %) underwent WLST. A logistic regression model revealed that Glasgow Coma Scale (GCS) (OR 0.82; 95 %-CI 0.77--0.87), cerebral edema (3.2; 1.5-7.0), craniotomy/craniectomy (2.5; 1.4-4.4), and DNAR (8.8; 5.5-14.3) were all independently associated with WLST. This model demonstrated excellent discrimination ability with a concordance statistic of 0.935.
Conclusions: This study demonstrates that patients ≥ 65 years old with poor initial GCS, cerebral edema, craniotomy/craniectomy, and DNAR were all independently associated with WLST. Pre-injury frailty was not associated with WLST. Further studies are needed to evaluate the prognostic value of frailty indices in the management of patients with TBI.
Keywords: Frailty; Traumatic brain injury; Withdrawal of life-sustaining therapies.
Copyright © 2025 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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