Research shows life-support decisions for the brain-injured should not be taken quickly | Fieldfisher
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Research shows life-support decisions for the brain-injured should not be taken quickly

I am regularly instructed by the families of people left catastrophically brain-injured, usually following serious road collisions. Because of the severity of the injuries, the families often face the most terrible decisions about the appropriate care of their relative and initial medical discussions often include the possibility of withdrawing life support if the situation deteriorates.

Fortunately, there are some incredible stories, some involving my clients, of doctors suddenly detecting more brain activity than they hoped for, offering hope for a level of recovery that generates quality of life above and beyond initial prognosis.

I had one client, very seriously injured and left in a minimally conscious state when the car in which she was a passenger hit a tree. Her condition was so severe that at a certain point, life support was withdrawn. Amazingly, she continued to survive by self-ventilating and care was resumed.

Later, once under the care of the specialist neuro team at the Wellington Hospital, doctors spotted significant signs of understanding from my client, particularly in her response to music. This allowed them to target her rehabilitation therapy and find more and more methods of two-way communication. She now resides in her own flat with live-in carers and has developed a good relationship with her husband and son, something that would have seemed inconceivable at the start.

Now, a new research study in the US has contributed to a body of evidence suggesting decisions about withdrawing life-sustaining treatment for patients with moderate-to-severe traumatic brain injury (TBI) should definitely not be made in the first days following injury. Currently, withdrawal of life support based on early prediction of poor outcome accounts for most deaths in patients hospitalised with severe TBI. The primary cause of the injury was car and motorcycle crashes in which the patient had been a driver/passenger, pedestrian or cyclist.

The researchers led by UC San Francisco, Medical College of Wisconsin and Spaulding Rehabilitation Hospital followed 484 patients with moderate-to-severe TBI. They found that among the patients in a vegetative state, 1 in 4 'regained orientation', that is knew who they were, where they were and the date, within 12 months of their injury.

The patients, with an average age of 35, were assessed using the Glasgow Outcomes Scale Extended (GSOE) which ranges from 1 for death to 8 for 'upper good recovery' and resumption of normal life.

At two weeks post-injury, 93 percent of the severe TBI group and 79 percent of the moderate TBI group had moderate-to-severe disability and required help in basic everyday living.

Amazingly, by 12 months, half of the severe TBI group and three-quarters of the moderate TBI group had GOSE scores of at least 4, showing they could function independently at home for at least eight hours a day. Even more incredibly, 19 percent of the severe TBI group had no disability, and a further 14 percent had only mild injury.

The study notes that the most surprising findings were for the 62 surviving patients who had been in a vegetative state, in which a person shows no signs of awareness. All patients had recovered consciousness by the 12-month mark and 14 of the 56 (1 in 4) had regained orientation. All but one survivor in this group recovered the ability for at least basic communication.

I have seen first-hand the amazing work performed by the neuro team at the Wellington once a patient is in their hands, but to get there, a patient has often been assessed within a non-specialist department of the hospital nearest to the accident site. It is likely here that the terrible decision is made to withdraw life support.

This study highlights both the importance of specialist intervention as soon as possible and provides evidence that doctors should refrain from telling families that a patient's prognosis is beyond hope since severe and acute impairment at first does not necessarily indicate a poor long-term outcome.

Read more about our brain injury claims.