Each year more than 1.7 million people experience traumatic brain injury. This qualitative descriptive study sought to describe how surrogate decision makers for patients with severe traumatic brain injury made the decision to withdraw or continue life support, and whether they believed that the health care team could have been of greater assistance. Six of 10 surrogates elected to withdraw life-sustaining treatment. Eight surrogates said that they would make the same proxy decisions if they had to do it again. Surrogates used multiple inputs to make treatment decisions and described the need for support from a trauma advanced practice nurse or palliative care team.