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Tytuł:
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Older Patients With Severe Traumatic Brain Injury: National Variability in Palliative Care.
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Autorzy:
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Hwang F; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address: .
Pentakota SR; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Glass NE; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Berlin A; Department of Surgery, Columbia University Medical Center, New York, New York.
Livingston DH; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Mosenthal AC; Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
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Źródło:
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The Journal of surgical research [J Surg Res] 2020 Feb; Vol. 246, pp. 224-230. Date of Electronic Publication: 2019 Oct 10.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
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MeSH Terms:
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Advanced Trauma Life Support Care/*statistics & numerical data
Brain Injuries, Traumatic/*therapy
Palliative Care/*statistics & numerical data
Practice Patterns, Physicians'/*statistics & numerical data
Trauma Centers/*statistics & numerical data
Advanced Trauma Life Support Care/organization & administration ; Advanced Trauma Life Support Care/trends ; Age Factors ; Aged ; Aged, 80 and over ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/mortality ; Databases, Factual/statistics & numerical data ; Female ; Health Services Needs and Demand/organization & administration ; Health Services Needs and Demand/statistics & numerical data ; Health Services Needs and Demand/trends ; Hospital Mortality ; Humans ; Injury Severity Score ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Palliative Care/standards ; Palliative Care/trends ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/standards ; Practice Patterns, Physicians'/trends ; Quality Improvement/organization & administration ; Quality Improvement/statistics & numerical data ; Quality Improvement/trends ; Retrospective Studies ; Trauma Centers/organization & administration ; Trauma Centers/trends ; United States
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Contributed Indexing:
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Keywords: Geriatric trauma; Intensity of treatment; Older patients; Surgical palliative care; Traumatic brain injury
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Entry Date(s):
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Date Created: 20191014 Date Completed: 20200221 Latest Revision: 20200221
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Update Code:
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20240105
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DOI:
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10.1016/j.jss.2019.09.002
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PMID:
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31606512
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Background: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma patients has been variable across the nation. The goal of this study was to assess PC utilization and intensity of care in older patients with severe TBI. We hypothesized that PC is underutilized despite its positive effects.
Materials and Methods: The National Inpatient Sample database (2009-2013) was queried for patients aged ≥55 y with International Classification of Diseases, Ninth Revision codes for TBI with loss of consciousness ≥24 h. Outcome measures included PC rate, in-hospital mortality, discharge disposition, length of stay (LOS), and intensity of care represented by craniotomy and or craniectomy, ventilator use, tracheostomy, and percutaneous endoscopic gastrostomy.
Results: Of 5733 patients, 78% died in hospital with a median LOS of 1 d, and 85% of the survivors were discharged to facilities. The overall PC rate was 35%. Almost 40% of deaths received PC, with nearly half within 48 h of admission. PC was used in 26% who had neurosurgical procedures, compared with 35% who were nonoperatively managed (P = 0.003). PC was associated with less intensity of care in the entire population. For survivors, those with PC had significantly shorter LOS, compared with those without PC.
Conclusions: Despite high mortality, only one-third of older patients with severe TBI received PC. PC was associated with decreased use of life support and lower intensity of care. Significant efforts need to be made to bridge this quality gap and improve PC in this high-risk population.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
