M. Wooster4, A. Stassi5, J. Kurtz3, J. Hill2, M. Bonta6, M. C. Spalding2 2Grant Medical Center,Trauma And Acute Care Surgery,Columbus, OH, USA 3Doctor’s Hospital,General Surgery,Columbus, OH, USA 4Indiana University School Of Medicine,Trauma And Acute Care Surgery,Indianapolis, IN, USA 5University Of South Carolina, Palmetto Health-Richland,Trauma And Acute Care Surgery,Columbia, SC, USA 6Riverside Methodist Hospital,Trauma And Acute Care Surgery,Columbus, OH, USA
Introduction: The geriatric trauma population is growing and fraught with poor physiological response to injury and high mortality rates. We investigated end of life (EOL) decision making of geriatric trauma patients. We hypothesize that age, religion, injury severity score (ISS), decision maker, pre-existing medical conditions, living wills/advanced directives/do not resuscitate status, and in-hospital complications will affect decision making regarding continued life support (CLS) versus withdrawal of care (WOC).
Methods: We performed a retrospective review of geriatric trauma patients at a level I and level II trauma center from January 1, 2007 to December 31, 2014. 274 patients met inclusion criteria with 144 patients undergoing CLS and 130 WOC.
Results: 35,747 geriatric trauma patients were admitted. Age, Catholicism, insurance type, massive transfusion protocol, antithrombotic therapy, ventilator days, ICU length of stay (LOS), and overall LOS were found to be statistically significant (p<0.05) predictors of WOC. After logistic regression, insurance type and Injury Severity Score were found to be significant (p=0.013/0.045). WOC patients had shorter time to palliative consultation. Patients with geriatrics consultation were 16.1 times more likely to undergo CLS (p=0.026). There was no difference in outcomes relative to patients advanced directives/living will/do not resuscitate status prior to hospital admission. However, 16% (44/274) of patients who underwent CLS or WOC had an advanced directive/living will/do not resuscitate status prior to hospital admission eventually progressed to WOC.
Conclusion: Our study examined the complex nature of EOL decisions and revealed difficulty in discerning progression to WOC versus CLS based on demographics, pre-hospital, and in-hospital factors. We also observed an apparent disconnect between the patient's wishes via living wills/advanced directives/do not resuscitate orders and fulfillment during EOL decision-making. Both geriatric and palliative care consultations are encouraged and may influence end of life decision making in geriatric trauma patients.
