To characterize critically ill patients with acute traumatic brain injury (TBI) who die after withdrawal of life-sustaining therapy (WLST) in a United States Level I Trauma Center.

Eighty-three of 100 patients survived acute hospitalization after TBI. There were sixty-one patients with severe (Glasgow Coma Scale [GCS] 3–8), fourteen with moderate (GCS 9–12), and twenty-four with mild TBI (GCS 13–15). Of the 17 patients who died, 15 died following WLST. Compared to survivors, non-survivors who died after WLST were: 1) significantly older than survivors (median [interquartile range] age = 79 [67.0–87.0] versus 49 [27.0–63.0] years), 2) more likely to sustain a TBI due to a fall (71% versus 43%) and 3) had lower ICU GCS scores (highest ICU GCS = 9 [6.0–14.0] versus 15 [15.0–15.0]). The median time from injury to death after WLST was 4 [2.0–8.0] days.

WLST was the most common cause of in-hospital death in critically ill patients with TBI and typically occurred within the first week of hospitalization. Patients who died were older, more likely to be injured due to a fall, and had more severe injuries. However, substantial variability in these results suggests that other factors contribute to decision-making regarding WLST.