Page 34 - Deleware Medical Journal - September/October 2019
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Considerations
of Futility in Trauma
Michael Farrell, MD, MS; Raymond Green, MD
Considerations of Futility in Trauma
The debate of medical futility surrounds two primary areas: 1) provide an appropriate level of care for patients. Futility in the trauma population is uniquely challenging due to the acute nature of the injuries with complex prognostic considerations. Additionally, the large and diverse trauma patient population allows for a wide range of both survivability and quality-of-life considerations. Despite these challenges, clinicians caring for trauma patients are often forced to make early decisions with limited information that can have long- lasting consequences.
Futility comes from the Latin word
and failed of the desired end through intrinsic defects.”1 At its origins, it
comes from the mythological story of the daughters of Danaus, who were sentenced leaking jar. Essentially, the point was that despite maximum efforts, the desired effect would never be reached.
The Trauma Quality Improvement Project (TQIP) by the American College of Surgeons (ACS) has attempted to provide broad guidance on how to approach potentially futile situations in its “palliative assessment report.”2 TQIP recommends that palliative goals of any hospitalization should include symptom management, emotional support, and good interdisciplinary and family communication. This approach requires an early palliative care assessment
that includes obtaining any advanced directives, performing a prognostication assessment, and screening for further
palliative needs. In addition, TQIP recommends that a goals-of-care family meeting should occur within 72 hours.
At their core, these recommendations are designed to establish open communication between the care team and the patient/ patient’s family. Unfortunately, the TQIP guidelines do not provide assistance
with patients in acutely life-threatening conditions.
In 2014, The American Association
for the Surgery of Trauma attempted
to better understand how acute care surgeons view futility and how it impacts their care plans.3 A total of 205 active surgeons completed a survey with a
percent of respondents believed that medical futility can be determined; of these respondents, approximately half had ceased treatment within the last year on
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Del Med J | September/October 2019 | Vol. 91 | No. 5
