Highlights
- •Palliative care consultation rate for elderly patients with traumatic brain injury (TBI) is low.
- •Baseline dementia and severe TBI are associated with palliative care consultation.
- •Average palliative care consultation timing was at 8.6 days.
- •Patients with palliative care had longer admissions, more days intubated, and higher costs.
- •Patients with earlier-than-average palliative care had lower costs and shorter hospitalization.
Abstract
We identified factors and outcomes associated with inpatient palliative care (PC)
consultation, stratified into early and late timing, for patients over age 65 with
traumatic brain injuries (TBI). Patients over age 65 presenting to a single institution
with TBI and intracranial hemorrhage from January 2013-September 2020 were included.
Patient demographics and various outcomes were analyzed. Inpatient PC consultation
was uncommon (4 % out of 576 patients). Characteristics associated with likelihood
of consultation were severe TBI (OR = 5.030, 95 % CI 1.096–23.082, p =.038) and pre-existing
dementia (OR = 6.577, 95 % CI 1.726–25.073, p =.006). Average consultation timing
was 8.6 (standard deviation ± 7.0) days. Patients with PC consults had longer overall
(p =.0031) and intensive care unit (ICU) length of stays (LOS) (p <.0001), more days
intubated (p <.0001) and higher costs (p =.0006), although those with earlier-than-average
PC consultation had shorter overall (p =.0062) and ICU (p =.011) LOS as well as fewer
ventilator days (p =.030) and lower costs (p =.0003). Older patients with TBI are
more likely to receive PC based on pre-existing dementia and severe TBI. Patients
with PC consultations had worse LOS and higher costs. However, these effects were
mitigated by earlier PC involvement. Our study emphasizes the need for timely PC consultation
in a vulnerable patient population.
Abbreviations:
ED (Emergency department), GCS (Glasgow Coma Score), ISS (Injury severity score), ICD (International Statistical Classification of Diseases and Related Problems), ICU (Intensive care unit), LOS (Length of stay), NIS (National Inpatient Sample), PC (Palliative care), TBI (Traumatic brain injury)Keywords
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Article info
Publication history
Accepted:
December 15,
2022
Received:
August 16,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
