In-hospital end-of-life decisions after new traumatic spinal cord injury in the Netherlands

Abstract

Study design:Explorative retrospective files study.Objectives: To document end-of-life decisions (ELDs) in in-hospital deaths after new traumatic spinal cord injury (TSCI).Setting:The Netherlands. Methods: Discharge letters concerning patients with TSCI discharged from Dutch acute hospitals in 2010 were analysed. Data were extracted on survival, personal and lesion characteristics, comorbidities, other injuries, preexisting spinal stenosis, stabilising surgery, length of hospital stay and the presence and types of ELDs. Characteristics of deceased patients and survivors were compared using χ 2 and T-tests. Characteristics of the deceased patients and ELDs were further explored. Results: A total of 185 patients with new TSCI were identified. Twenty-six patients were excluded as their survival status at discharge was unknown - for example, because of discharge to another hospital without information about their final discharge. Thirty of the remaining 159 patients died during their initial hospital stay (18.9%). Deceased patients were older and had more often high cervical and motor complete injuries than survivors. The circumstances of death were sparsely documented, and in nine cases, it was not possible to determine the absence or the presence of an ELD. ELDs were reported in 19 deaths (63.3%). All were non-treatment decisions, and almost all (89.5%) were decisions of withdrawal of treatment. There were no cases of documented euthanasia or physician-assisted suicide. Conclusion: ELDs were reported in the majority of in-hospital deaths after new TSCI in the Netherlands (63.3%), and all were non-treatment decisions.