Back to Search
Start Over
Clinical Outcomes After Early Palliative Care Evaluations in Geriatric Trauma Intensive Care.
- Source :
-
The Journal of surgical research [J Surg Res] 2024 Oct; Vol. 302, pp. 359-363. Date of Electronic Publication: 2024 Aug 16. - Publication Year :
- 2024
-
Abstract
- Introduction: Older trauma patients are at risk for worse outcomes compared to younger patients. We hypothesized that early initiation of palliative care (EPC) evaluations, within 72 h of trauma intensive care unit (ICU) admission, would be associated with reduced invasive procedures without a change in hospital mortality.<br />Methods: A retrospective cohort review was performed of all trauma patients aged ≥65 y admitted to the trauma (ICU) from January 1, 2016, to December 31, 2021. Patients who received formal palliative care assessments were included. Patient demographics and injury characteristics were evaluated. The primary outcome was ICU length of stay (LOS). Secondary outcomes included code status change, tracheostomy or percutaneous endoscopic gastrostomy placement, use and length of mechanical ventilation, in-hospital mortality, and withdrawal of life-sustaining care.<br />Results: Two hundred twenty-five patients met inclusion. One hundred and six had EPC while 119 had late palliative care. EPC was associated with decreased ICU LOS (3 versus 9 d, P < 0.001), hospital LOS (3 versus 11 d, P < 0.001), and days on mechanical ventilation (P < 0.001), and fewer tracheostomy (P = 0.007) and percutaneous endoscopic gastrostomy tubes (P = 0.049). There was no difference in withdrawal of life-sustaining care (P = 0.581) or in-hospital mortality (P = 0.172). Pre-existing code status or code status clarification early in admission was associated with EPC (P = 0.003) and decreased interventions.<br />Conclusions: EPC is associated with decreased LOS and fewer invasive procedures without a change in hospital mortality. Early discussions regarding code status are helpful in decreasing hospital costs and futile interventions. Further investigation is required to standardize palliative care in this population.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Aged
Male
Retrospective Studies
Female
Aged, 80 and over
Wounds and Injuries therapy
Wounds and Injuries mortality
Intensive Care Units statistics & numerical data
Critical Care statistics & numerical data
Respiration, Artificial statistics & numerical data
Palliative Care statistics & numerical data
Hospital Mortality
Length of Stay statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1095-8673
- Volume :
- 302
- Database :
- MEDLINE
- Journal :
- The Journal of surgical research
- Publication Type :
- Academic Journal
- Accession number :
- 39153356
- Full Text :
- https://doi.org/10.1016/j.jss.2024.07.062