1114 Family-Provider Interactions Associated With Decreased Withdrawal of Life-Sustaining Therapy Among Patients With Traumatic Brain Injury Receiving Palliative Care

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INTRODUCTION: Traumatic brain injury (TBI) often results in critical illness requiring decisions about the continuation or withdrawal of life-sustaining therapy (WLST). Palliative care consultation plays a central role in facilitating these decisions, yet the impact of family dynamics on WLST remains underexplored. METHODS: We conducted a multi-center retrospective cohort study of patients with TBI admitted to a unified health system between 2016 and 2022 who received both neurosurgical and palliative care consultations. Key exposures included the number of family-provider interactions prior to palliative care consultation and identity of the primary surrogate decision-maker. The primary outcome was WLST. Multivariable logistic regression, LASSO regression, and decision tree modeling were used to assess associations with WLST while adjusting for potential clinical confounders including injury severity and treatment intensity. RESULTS: Among 228 patients with TBI (median age 81 years, 53% male), 51% (N = 117) experienced WLST. A greater number of family-provider interactions prior to palliative consultation was associated with lower odds of WLST (OR, 0.95; P = 0.022), while greater midline shift (MLS) on initial CT was associated with higher odds of WLST (OR, 1.09 per mm; P = 0.024). Identity of the surrogate decision-maker was not associated with WLST. LASSO regression confirmed MLS and family-provider interactions as key associations, and the decision tree model identified an MLS threshold of 4.25 mm as the primary determinant of WLST. CONCLUSIONS: Family engagement and initial MLS may be associated with WLST in older TBI patients receiving palliative care. Increased early family-provider communication is associated with reduced WLST likelihood, while greater MLS is associated higher WLST likelihood. These findings suggest that proactive communication with families may meaningfully influence end-of-life decision-making beyond clinical severity alone and should be prioritized during the treatment of patients with TBI when feasible.

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