Decisions to withdraw life support treatments in critically ill patients with severe brain injury are complicated, are based on many factors, and are usually made by critical care physicians and families in the intensive care unit (ICU). A study in Canadian Medical Association Journal provides new understanding on the decision-making processes for this patient population, which accounts for most hospital deaths from trauma. Most deaths in critically ill patients with severe traumatic brain injury (TBI) occur after a decision to withdraw life-sustaining treatments. This patient population differs from the general ICU population as most patients were healthy before admission to the ICU, as compared with older patients who may already have poorer quality of life due to pre-existing illness. Therefore, decisions to withdraw life-sustaining treatments are made differently, mainly based on long-term prognosis and quality of life.

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