Traumatic brain injury (TBI) presents a high risk for morbidity and mortality in elderly individuals, with individuals over age 75 accounting for 32% of hospitalizations and 28% of deaths related to TBI. The American College of Surgeons Trauma Quality Improvement Program recommends palliative care screening for elderly individuals with moderate to severe TBI, given the poor prognosis of TBI at this age. For TBI requiring neurosurgery, there is a 25% in-hospital mortality rate and, for those who survive surgery, a 50% mortality rate within one year. Moreover, TBI presents a critical quality of life concern for elderly individuals because it is associated with the development of depression and dementia. It is important for patients in this age group to have a conversation about their goals for care, including those regarding palliative care.
Despite the importance of palliative care discussions in elderly patients with TBI, there is little research on how frequently inpatient palliative care discussions occur. To investigate this gap in literature, as well as determine the potential benefits of palliative care consultations, a team of researchers studied 576 patients over the age of 65 who were admitted to the emergency department with TBI, to determine the frequency and factors associated with palliative care consultation.
The study’s major finding showed that of the 576 patients assessed, only 23 (4%) received palliative care consultation. Significantly higher proportions of individuals with dementia and functional dependence received palliative care consultations compared to other preexisting conditions. The researchers grouped individuals who receive palliative care consultation into early and late groups, depending on when they received a consultation (i.e., before or about a week after hospitalization). They found that patients receiving palliative care early in their hospitalization had significantly shorter average hospital stays and significantly lower average hospital costs than the late group.
Inpatient palliative care consultation may depend on numerous factors, including injury severity, comorbidities, and declining clinical status. Early palliative care and conversations about goals of care are beneficial to elderly patients with TBI, particularly in terms of cost and length of hospital stays. This study highlights the need for robust palliative care screening for elderly individuals in traumatic injury settings.
Wu A, Zhou J, Quinlan N, et al. Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: Insights from a Level 1 trauma center. Journal of Clinical Neuroscience. (February 2023).