Decisions to limit treatment in a neurosurgical unit: an aspect of audit of mortality.

The monthly audit of deaths in this regional neurosurgical unit notes decisions to limit treatment recorded in the case-sheet. In 1988 a treatment-limiting decision was noted in 67 of 131 deaths (51%). In 40% of these the decision was made soon after admission; in these patients the mean time to death was 1.5 days (median one day). When the decision was made later, the mean time for admission to death was 6.8 days (median five days). Regular audit provides an opportunity to discuss the appropriateness of such decisions in various circumstances.