- •Little is known about potential disparities in end-of-life trauma care.
- •Adjusted odds of Withdrawal of Life Sustaining Treatment were lower in Blacks (OR 0.48 and Hispanics (OR 0.71) than Whites.
- •Among non-head injured dying patients, Blacks and Hispanics are less likely to utilize WLST than Whites.
- •Further investigation into the socio-cultural norms and institutional distrust influencing these differences is imperative.
Little is known about potential disparities in end-of-life care in trauma. We examined racial/ethnic differences in withdrawal of life-sustaining treatment (WLST) in non-head injury trauma.
We retrospectively analyzed the National Trauma Databank (2017–2018), including patients ≥ 18 years without head injury. We performed a bivariate analysis by WLST status and used logistic regression to estimate adjusted odds of WLST by racial/ethnic group.
Of 942,914 identified, 20,052 (2.1%) died. Of those who died, WLST occurred in 29.9%. The adjusted odds of WLST were lower in Blacks (OR 0.48, 95% CI 0.41–0.57) and Hispanics (OR 0.71, 95% CI 0.57–0.89) than Whites. The predicted probability of WLST in Black patients remained lower than Whites at 30 days.
Among non-head injured dying patients, Blacks and Hispanics are less likely to utilize WLST than Whites. Further investigation into the socio-cultural norms and institutional distrust influencing these differences is imperative.
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- 10 Leading Causes of Death.(United States)2019 (Published)https://wisqars-viz.cdc.gov:8006/lcd/home(Accessed)Date accessed: April 16, 2021
- The epidemiology of trauma-related mortality in the United States from 2002 to 2010.J Trauma Acute Care Surg. 2014; 76: 913-920https://doi.org/10.1097/TA.0000000000000169
- Traumatic injury in the United States: in-patient epidemiology 2000-2011.Injury. 2016; 47: 1393-1403https://doi.org/10.1016/j.injury.2016.04.002
- The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study.J Trauma Acute Care Surg. 2019; 86: 864-870https://doi.org/10.1097/TA.0000000000002205
- Quadrimodal distribution of death after trauma suggests that critical injury is a potentially terminal disease.J Crit Care. 2015; 30 (e1-7): 656https://doi.org/10.1016/j.jcrc.2015.01.003
- Defining futile and potentially inappropriate interventions: a policy statement from the society of critical care medicine ethics committee.Crit Care Med. 2016; 44: 1769-1774https://doi.org/10.1097/CCM.0000000000001965
- Withdrawal of care in a trauma intensive care unit: the impact on mortality rate.Am Surg. 2014; 80: 764-767
- Limitation of life-sustaining care in the critically ill: a systematic review of the literature.J Hosp Med. 2019; 14: 303-310https://doi.org/10.12788/jhm.3137
- Variation in decisions to forgo life-sustaining therapies in US ICUs.Chest. 2014; 146: 573-582https://doi.org/10.1378/chest.13-2529
- The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU.Chest. 2011; 139: 1025-1033https://doi.org/10.1378/chest.10-3011
- Current research findings on end-of-life decision making among racially or ethnically diverse groups.Gerontol. 2005; 45: 634-641https://doi.org/10.1093/geront/45.5.634
- Racial variations in end-of-life care.J Am Geriatr Soc. 2000; 48: 658-663https://doi.org/10.1111/j.1532-5415.2000.tb04724.x
- Use of palliative care and hospice among surgical and medical specialties in the veterans health administration.JAMA Surg. 2014; 149: 1169https://doi.org/10.1001/jamasurg.2014.2101
- Surgical buy-in: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy.Crit Care Med. 2010; 38: 843-848https://doi.org/10.1097/CCM.0b013e3181cc466b
- Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians.Chest. 2014; 145: 313-321https://doi.org/10.1378/chest.13-1351
- Integrating palliative care in the surgical and trauma intensive care unit: a report from the improving palliative care in the intensive care unit (IPAL-ICU) project advisory board and the center to advance palliative care.Crit Care Med. 2012; 40: 1199-1206https://doi.org/10.1097/CCM.0b013e31823bc8e7
- Racial disparities in intensity of care at the end-of-life: are trauma patients the same as the rest?.J Health Care Poor Underserved. 2012; 23: 857-874https://doi.org/10.1353/hpu.2012.0064
- Examining racial disparities in the time to withdrawal of life-sustaining treatment in trauma.J Trauma Acute Care Surg. 2018; 84: 590-597https://doi.org/10.1097/TA.0000000000001775
- Predictors of withdrawal of life support after burn injury.Burns. 2019; 45: 322-327https://doi.org/10.1016/j.burns.2018.10.015
- National Trauma Data Bank 2016: Annual Report.2016https://www.facs.org/-/media/files/quality-programs/trauma/ntdb/ntdb-annual-report-2016.ashx(Accessed)Date accessed: May 3, 2021
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994; 47: 124-1251
- Application of the shock index to the prediction of need for hemostasis intervention.Am J Emerg Med. 2013; 31: 1260-1263https://doi.org/10.1016/j.ajem.2013.05.027
- Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index.J Trauma Inj Infect Crit Care. 2011; 70: 384-390https://doi.org/10.1097/TA.0b013e3182095a0a
- Does admission to the ICU prevent african American disparities in withdrawal of life-sustaining treatment?.Crit Care Med. 2017; 45: e1083-e1086https://doi.org/10.1097/CCM.0000000000002478
- Racial and ethnic differences in preferences for end-of-life treatment.J Gen Intern Med. 2009; 24: 695-701https://doi.org/10.1007/s11606-009-0952-6
- Comfort care in trauma patients without severe head injury: in-hospital complications as a trigger for goals of care discussions.Injury. 2019; 50: 1064-1067https://doi.org/10.1016/j.injury.2019.01.024
- Withdrawal of life-sustaining therapy in injured patients: variations between trauma centers and nontrauma centers.J Trauma. 2009; 66: 1327-1335https://doi.org/10.1097/TA.0b013e31819ea047
- Withdrawal of care: a 10-year perspective at a Level I trauma center.J Trauma Acute Care Surg. 2012; 72: 1186-1193https://doi.org/10.1097/TA.0b013e31824d0e57
- Early comfort care following operative intervention for traumatic injury.Am Surg. 2020; 86: 933-936https://doi.org/10.1177/0003134820940255
- Patient characteristics associated with comfort care among trauma patients at a level I trauma center.Am Surg. 2018; 84: 1832-1835
- Withdrawal of life-sustaining treatment in a mixed intensive care unit: most common in patients with catastropic brain injury.Neurocritical Care. 2012; 16: 130-135https://doi.org/10.1007/s12028-011-9567-y
- Barriers to hospice care in trauma patients: the disparities in end-of-life care.Am J Hosp Palliat Care. 2018; 35: 1081-1084https://doi.org/10.1177/1049909117753377
- Ethnic differences in advance directive completion and care preferences: what has changed in a decade?.J Am Geriatr Soc. 2017; 65: 1352-1357https://doi.org/10.1111/jgs.14800
- Racial and ethnic differences in end-of-life care in the United States: evidence from the health and retirement study (HRS).SSM Popul Heal. 2019; 7100331https://doi.org/10.1016/j.ssmph.2018.100331
- End-of-Life wishes among non-hispanic Black and white middle-aged and older adults.J Racial Ethn Heal Disparities. October 2020; : 1-10https://doi.org/10.1007/s40615-020-00873-w
- Factors impacting advance care planning among african Americans: results of a systematic integrated review.J Palliat Med. 2016; 19: 202-227https://doi.org/10.1089/jpm.2015.0325
- ACS TQIP Best Practices for Palliative Care. 2017https://www.facs.org/-/media/files/quality-programs/trauma/tqip/palliative_guidelines.ashx(Accessed)Date accessed: May 18, 2021
- The role of palliative care in acute trauma: when is it appropriate?.Am J Surg. 2020; 220: 1456-1461https://doi.org/10.1016/j.amjsurg.2020.10.002
- Trauma care and palliative care: time to integrate the two?.J Am Coll Surg. 2003; 197: 509-516https://doi.org/10.1016/S1072-7515(03)00651-3
- Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review.Palliat Support Care. 2019; 17: 697-706https://doi.org/10.1017/S1478951519000403
Published online: August 05, 2021
Accepted: August 3, 2021
Received in revised form: July 21, 2021
Received: June 7, 2021
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