Factors influencing withdrawal of life-supporting treatment in cervical spinal cord injury: a large multicenter observational cohort study

Shakil, Husain; Malhotra, Armaan K.; Jaffe, Rachael H.; Smith, Christopher W.; Harrington, Erin M.; Wang, Alick P.; Yuan, Eva Y.; He, Yingshi; Ladha, Karim; Wijeysundera, Duminda N.; Nathens, Avery B.; Wilson, Jefferson R.; Witiw, Christopher D.

doi:10.1186/s13054-023-04725-x

Critical Care

Table 2 Summary of patient- and hospital-level fixed effect predictors associated with withdrawal of life-supporting treatment

From: Factors influencing withdrawal of life-supporting treatment in cervical spinal cord injury: a large multicenter observational cohort study

Predictors	Odds ratios	95% CI	p-value
Patient-level characteristics
Age (years)			< 0.001^a,b
Change from 20 to 30 years	1.37	0.67–2.06
Change from 60 to 70 years	1.83	1.40–2.26
Sex—reference: female
Male	1.36	1.09–1.68	0.006^a
Race—reference: white
Black	0.38	0.29–0.48	< 0.001^a
Asian	0.30	0.16–0.54	< 0.001^a
Other	0.53	0.37–0.76	< 0.001^a
Insurance type—reference: private/commercial
Medicaid	1.00	0.75–1.34	0.983
Medicare	1.37	1.06–1.76	0.014^a
Self-Pay	1.78	1.30–2.44	< 0.001^a
Other	1.23	0.83–1.81	0.306
Comorbidities
Functionally dependent	1.44	0.97–2.15	0.072
Prior Stroke	1.01	0.57–1.79	0.969
Dementia	1.81	1.07–3.06	0.027^a
Disseminated Cancer	1.05	0.44–2.52	0.907
Chronic Renal Failure	1.05	0.52–2.14	0.894
Presenting Glasgow Coma Scale—reference: 15
3–14	1.42	1.07–1.90	0.016^a
9–12	1.32	0.94–1.85	0.105
3–8	3.34	2.63–4.24	< 0.001^a
Shock	1.28	0.91–1.78	0.151
Pre-hospital cardiac arrest	1.92	1.49–2.48	< 0.001^a
Mechanism of injury—reference: blunt
Penetrating	1.80	1.26–2.59	0.001
Spinal cord level of injury—reference: C4 and below
C3 and above	1.99	1.63–2.42	< 0.001
Severe non-spinal injury—reference: Body system AIS < 3
Head AIS ≥ 3	1.54	1.24–1.91	< 0.001^a
Face AIS ≥ 3	1.09	0.44–2.70	0.852
Neck AIS ≥ 3	1.25	0.98–1.61	0.078
Thorax AIS ≥ 3	1.31	1.04–1.64	0.021^a
Abdomen AIS ≥ 3	1.01	0.64–1.58	0.973
Upper extremity AIS ≥ 3	1.17	0.49–2.78	0.725
Lower extremity AIS ≥ 3	1.39	0.97–2.00	0.070
Hospital-level characteristics
Hospital size (Beds)—reference: ≤ 200
201–400	0.77	0.47–1.26	0.294
401–600	0.91	0.56–1.49	0.716
> 600	0.72	0.44–1.18	0.195
Hospital teaching status—reference: university
Non-teaching	0.76	0.54–1.07	0.111
Community	0.94	0.75–1.18	0.602
Year of injury—reference: 2017
2018	0.90	0.71–1.14	0.381
2019	0.91	0.71–1.16	0.439
2020	0.80	0.63–1.02	0.074

^aStatistically significant
^bLikelihood ratio test
CI Confidence interval, AIS Abbreviated injury scale

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