Older Patients With Severe Traumatic Brain Injury: National Variability in Palliative Care

Franchesca Hwang, Sri Ram Pentakota, Nina E. Glass, Ana Berlin, David H. Livingston, Anne C. Mosenthal

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)224-230
Number of pages7
JournalJournal of Surgical Research
Volume246
DOIs
StatePublished - Feb 2020

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Palliative Care
Length of Stay
Traumatic Brain Injury
Survivors
Neurosurgical Procedures
Gastrostomy
Unconsciousness
Mortality
Craniotomy
Tracheostomy
International Classification of Diseases
Mechanical Ventilators
Hospital Mortality
Population
Inpatients
Outcome Assessment (Health Care)
Databases
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery

Keywords

  • Geriatric trauma
  • Intensity of treatment
  • Older patients
  • Surgical palliative care
  • Traumatic brain injury

Cite this

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title = "Older Patients With Severe Traumatic Brain Injury: National Variability in Palliative Care",
abstract = "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.",
keywords = "Geriatric trauma, Intensity of treatment, Older patients, Surgical palliative care, Traumatic brain injury",
author = "Franchesca Hwang and Pentakota, {Sri Ram} and Glass, {Nina E.} and Ana Berlin and Livingston, {David H.} and Mosenthal, {Anne C.}",
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Older Patients With Severe Traumatic Brain Injury : National Variability in Palliative Care. / Hwang, Franchesca; Pentakota, Sri Ram; Glass, Nina E.; Berlin, Ana; Livingston, David H.; Mosenthal, Anne C.

In: Journal of Surgical Research, Vol. 246, 02.2020, p. 224-230.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Older Patients With Severe Traumatic Brain Injury

T2 - National Variability in Palliative Care

AU - Hwang, Franchesca

AU - Pentakota, Sri Ram

AU - Glass, Nina E.

AU - Berlin, Ana

AU - Livingston, David H.

AU - Mosenthal, Anne C.

PY - 2020/2

Y1 - 2020/2

N2 - 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.

AB - 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.

KW - Geriatric trauma

KW - Intensity of treatment

KW - Older patients

KW - Surgical palliative care

KW - Traumatic brain injury

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