There are significant differences in the resources deployed in various Quebec trauma centres, according to a researcher from the Québec-Université Laval Research Centre.

The discrepancy is particularly large during the first 72 hours of hospitalizations, says Dr. Lynne Moore. 

“We see a lot of variation very early in the process, less than 72 hours after the patient arrives, and the recommendations are to wait before withdrawing acute care for these patients," Moore said.

She said the differences in approach are driven by a lack of data regarding the prognosis of severe trauma victims.

Moore and her colleagues examined the resources used to care for 2,044 patients who died of severe trauma in Quebec’s 57 trauma centers between 2013 and 2016. Most of the injuries had been caused by a fall or motor vehicle accident.

Of these patients, 37 per cent died during the first three days following hospital admission; another 37 per cent between days three and 14; and the remaining 26 per cent after day 14.

The researchers estimated the costs of surgical procedures, tests, and other treatments before death. They did not include physician compensation in their calculations.

They found differences of six to eight per cent in the resources that hospitals invest in these patients before death. The differences were particularly large in the under-65 age group and in patients who had suffered a traumatic brain injury.

“That’s not to say that care is not optimal," Moore said.

“But it may be a reflection of the fact that physicians currently lack prognostic tools for these patients. We have a patient who comes in with a very severe brain injury, and the prognosis is difficult to determine because doctors currently lack the tools.”

Discussions with the family and other members of the medical team also won’t be based on solid data, she added, especially regarding the consequences of stopping care.

The prognosis for patients with traumatic brain injuries is more difficult to determine because there is less evidence about the outcome of cases, Moore noted.

She explained that because there is less understanding of what determines brain recovery after severe trauma, there is less agreement among centres about when acute care can and should be stopped.

In Canada, about 70 per cent of people who die in hospital from a traumatic brain injury die when their loved ones decide to turn off the life-sustaining devices. In half of the cases, this decision is made within the first 72 hours of hospital admission.

The involvement of family and friends seems to play a major role in the decision to withdraw care, Moore said.

"From patient to patient, family care can be very different," she said.

"Living with sequelae [after-effects from an injury] may be acceptable to one family, while to another family it may be unacceptable.”

The culture of the various facilities could also play a role, said Moore; for example, the researchers found that large hospitals with the most sophisticated technology use more resources and possibly have more aggressive approaches.

The findings were published in the medical journal Annals of Surgery.

This report was first published by The Canadian Press on Jan. 20, 2022.