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Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: Insights from a Level 1 trauma center

      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)

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