Timing is everything : early versus late palliative care consults in trauma

Article indépendant

SPENCER, Audrey L. | RUSSELL, Gregory B. | CORNEA, Isabella | MILLER, Preston R. | MARTERRE, Buddy

Background: The incorporation of dedicated palliative care (PC) services in the care of the critically injured trauma patient is not yet universal. Preexisting data demonstrates both economic and clinical value of PC consults, yet patient selection and optimal timing of these consults is poorly defined, possibly leading to underutilization of PC services. Prior studies in geriatric patients have shown benefits of PC when PC clinicians are engaged earlier during hospitalization. We aim to compare hospitalization metrics of early versus late PC consultation in trauma patients. Methods: All patients age = 18 admitted to the trauma service between 1/1/19 and 3/31/21 who received a PC consult were included. Patients were assigned to EARLY (PC consult =3 days after admission) and LATE (PC consult >3 days after admission) cohorts. Demographics, injury and underlying disease characteristics, outcomes, and financial data were compared. Length of stay (LOS) in the EARLY group is compared to LOS-3 in the LATE group. Results: 154 patient records met inclusion criteria (60 EARLY and 94 LATE). Injury severity score, head abbreviated injury score, and medical comorbidities (congestive heart failure, dementia, previous stroke, chronic obstructive pulmonary disease, malignancy) were similar between the groups. The LATE group was younger (69.9 vs 75.3, p = 0.04). Patients in the LATE group had significantly longer LOS (17.5 vs 7.0 days, p < 0.01) and higher median hospital costs ($53,165 vs $17,654, p < 0.01). Patients in the EARLY group had reduced ventilator days (2.4 vs 7.0, p < 0.01) and reduced rates of tracheostomies and surgical feeding tubes (1.7 vs 11.7%, p = 0.03). Conclusions: Trauma patients with early PC consultation had shorter LOS, reduced ventilator days, reduced rates of invasive procedures and lower costs even after correcting for delay to consult in the late group. These findings suggest the need for mechanisms leading to earlier PC consult in critically injured patients.

http://dx.doi.org/10.1097/TA.0000000000003881

Voir la revue «The Journal of trauma and acute care surgery»

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