I. Puente1,2, A. Fokin2, J. Katz1, A. Tymchak2, J. Wycech1, S. Koff2, S. Viitaniemi2, R. Teitzman2 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma,Delray Beach, FL, USA
Introduction: Palliative care has been underutilized in the trauma ICU (TICU) setting in comparison to surgical and medical ICU settings. The characterization of palliative care trauma patients has yet to be delineated. The objective of this study was to analyze the characteristics of TICU patients who received palliative care consultation (PCC) and compare that data to patients who did not receive PCC.
Methods: In this IRB approved retrospective-cohort study, 331 TICU patients who received a PCC from 12/2012 – 05/2017 (PCC group) were compared to all 7,758 trauma patients (ATP group) who did not receive a PCC and to 331 trauma patients in a matched control group (MCG) that were matched by age, gender, Injury Severity Score (ISS), and Mechanism of Injury (MOI). All patients were identified through the database of a level 1 trauma center. Analyzed variables included age, gender, race, MOI, ISS, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and traumatic brain injury (TBI) incidence.
Results: The mean age in the PCC and MCG patients were similar (81.3 in PCC vs 81.0 in MCG, p=0.81) but, the mean age in the ATP group (56.8) was significantly lower (p<0.05). There was a 3:2 male to female ratio in all groups. Among all PCC patients (N=331), there were 304 white patients (91.8%), 6 black patients (1.8%), 4 Hispanic patients (1.2%), and 17 unidentified patients (5.1%). There was an unintended match in race distribution between the MCG and PCC group (p=0.74); however, in the ATP group the race distribution was significantly different (p<0.001) with fewer white patients (73% in ATP vs 91.8% in PCC) and more black patients (12% in ATP vs 1.8% in PCC). There were similar MOI distributions in all groups (p=0.45) with the dominant MOI being falls (81.6% for PCC and 78.9% for MCG) followed by MVCs (13.0% for PCC and 17.5% for MCG). In the ATP group, while the order of prevalence of MOI was the same (48.3% falls and 25.9% MVC), the degree of prevalence was different from the PCC and MCG groups (p<0.001). The mean ISS for the PCC and MCG patients were similar (20.3 in PCC vs 19.3 in MCG, p=0.26); however, the mean ISS for the ATP group (10.2) was significantly lower than in the PCC and MCG groups (p<0.05). The mean GCS in the PCC group (11.0) was significantly lower when compared to the MCG group (12.8, p<0.001) and the ATP group (13.7, p<0.001). The mean RTS in the PCC group (6.78) was also significantly lower when compared to the MCG group (7.11, p<0.01) and the ATP group (7.44, p<0.001). The TBI incidence in the PCC group (72.8%) and MCG group (71.6%) was similar (p=0.73); however, TBI incidence was significantly lower in the ATP group (44.0%, p<0.001).
Conclusion: Trauma patients who received palliative care consultation were significantly older, predominantly white, male, more severely injured, and had a higher incidence of traumatic brain injury with a lower neurological status.