Advances in the treatment of burn injuries has improved survival rates in recent decades, especially for patients with severe, life-threatening injuries. However, there is still a small portion of patients (approximately 1% in high income countries such as Australia) who present with potentially non-survivable injuries. Some patients with non-survivable injuries rapidly deteriorate without active care, while others require comfort or end-of-life care for an ongoing period.
Clinicians are increasingly required to consider more nuanced aspects of patient care such as long-term quality of life, as well as patient beliefs and values when deciding to either withhold (not deliver) or withdraw (cease delivery) of life-sustaining treatment in patients with potentially non-survivable injuries.
Little is known about treatment decision-making in patients with a potentially non-survivable injury in Australia and New Zealand.
Now, new research from a collaborative team of researchers and clinicians at Monash University and The Alfred explores the frequency of decisions to withhold or withdraw treatment following potentially non-survivable injury and compared the characteristics of patients who had treatment withdrawn or withheld.
Data from the Burns Registry of Australia and New Zealand for patients who died between July 2009 and June 2020 were obtained. Of the 327 patients who died in specialist burn services over the 11-year period, the majority (69%) received some level of life-sustaining treatment initially before it was later withdrawn.
Only a small proportion of patients (17%) did not receive any active treatment as their injuries were deemed non-survivable on admission. Older patients or patients with burns affecting a larger proportion of their body had reduced odds of active treatment being initiated.
The decision to withhold active treatment was made more quickly than the decision to withdraw treatment that had been initiated. These results suggest specialist burn care clinicians may need to consider many factors as part of their decision-making process to determine which care pathway is pursued.
Read the full paper, “Treatment Decisions in Patients with Potentially Non-Survivable Burn Injury in Australia and New Zealand: A Registry-based Study” which is currently in press at the Journal of Burn Care & Research here.
Please contact corresponding author Dr Lincoln Tracy (lincoln[dot]tracy[at]monash[dot]edu) if you are unable to access the article.
This research was supported by a grant from the Bethlehem Griffiths Research Foundation (grant number BGRF2018). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.