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Invited Commentary
June 17, 2020

Dying of Traumatic Brain Injury—Palliative Care too Soon, or too Late?

Author Affiliations
  • 1Lahey Hospital Medical Center, Beth Israel Lahey Health, Tufts University School of Medicine, Burlington, Massachusetts
JAMA Surg. Published online June 17, 2020. doi:10.1001/jamasurg.2020.1810

Severe traumatic brain injury (TBI) carries high mortality and survivors experience high rates of disability and functional dependence. With such poor outcomes, these are patients with substantial palliative care needs. High-quality care should include palliative care for all those whose outcomes do not align with their goals, not just those for whom death is imminent. However, in practice, providing this consistently for patients with severe TBI remains a challenge. Despite rates of death and disability, surgeons still struggle with when and whether to recommend a transition to palliative care or withdrawal of life support. This manifests in various ways, including the low rate of palliative care use for patients with TBI1 and variability in end-of-life care based on geography, socioeconomic, and trauma center status.2,3 Williamson et al4 describe the variability of withdrawal of life support at trauma centers participating in American College of Surgeons Trauma Quality Improvement Program based on geography, insurance status, and race.

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