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Some patients with brain injuries have life support withdrawn too soon, study suggests

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Life support for patients with severe traumatic brain injury (TBI) may sometimes be withdrawn too early, when it's possible that patients could eventually recover, new research suggests

Every day, just under 200 Americans are estimated to die from a TBI, most commonly caused by fall, firearm-related injury or car crash.  

Patients with severe TBI face a high risk of death or long-term disabilities that can affect their physical and cognitive abilities. People with these severe injuries may be given life-support in a hospital's intensive care unit (ICU); this care might include the use of a ventilator to assist breathing and drugs to reduce fluid build-up in the body. However, if doctors think a patient is unlikely to make a meaningful recovery, this support may be withdrawn.  

According to the American College of Surgeons, patients with severe TBI in the ICU should receive "full treatment" for at least 72 hours after they sustain an injury. However, in the U.S., there are currently no clinical guidelines as to which patients should then have life support withdrawn or when that should happen. 

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"We know that prognosis, or determining how somebody is going to recover after a severe traumatic brain injury, is incredibly imprecise," co-senior study author Yelena Bodien, an assistant professor in neurology at the Massachusetts General Hospital, told Live Science. "We are not able to give families precise information about whether their loved one will recover, to what degree and when," she said. 

Clinicians often have to predict within just a few days of a patient's injury whether they are likely to die, develop a long-term disability or make a significant recovery. Doctors typically make these predictions based on clinical factors, such as the severity of a patient's injury — but again, there aren't standardized guidelines for how they should make their final prognosis. The prognosis is then relayed to a patient's caregivers and loved ones, who are often tasked with deciding whether to withdraw life support from the patient or not. 

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