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Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?

Publication ,  Journal Article
Williamson, TL; Adil, SM; Shalita, C; Charalambous, LT; Mitchell, T; Yang, Z; Parente, BA; Lee, H-J; Ubel, PA; Lemmon, ME; Galanos, AN ...
Published in: Neurocrit Care
June 2022

BACKGROUND: Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of patients with sTBI who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare health care resource utilization between patients with or without PCEs. METHODS: The National Inpatient Sample database was queried for patients age  ≥  18 who had a diagnosis of sTBI, defined by using International Classification of Diseases, 9th Revision codes. PCEs were defined by using International Classification of Diseases, 9th Revision code V66.7 and trended from 2001 to 2015. To assess factors associated with PCE in patients with sTBI, we performed unweighted generalized estimating equations regression. PCE association with decision making was modeled via its effect on rate of percutaneous endoscopic gastrostomy (PEG) tube placement. To quantify differences in PCE-related decisions by race, race was modeled as an effect modifier. RESULTS: From 2001 to 2015, the proportion of palliative care usage in patients with sTBI increased from 1.5 to 36.3%, with 41.6% White, 22.3% Black, and 25% Hispanic patients with sTBI having a palliative care consultation in 2015, respectively. From 2008 to 2015, we identified 17,673 sTBI admissions. White and affluent patients were more likely to have a PCE than Black, Hispanic, and low socioeconomic status patients. Across all races, patients receiving a PCE resulted in a lower rate of PEG tube placement; however, White patients exhibited a larger reduction of PEG tube placement than Black patients. Patients using palliative care had lower total hospital costs (median $16,368 vs. $26,442, respectively). CONCLUSIONS: Palliative care usage for sTBI has increased dramatically this century and it reduces resource utilization. This is true across races, however, its usage rate and associated effect on decision making are race-dependent, with White patients receiving more PCE and being more likely to decline the use of a PEG tube if they have had a PCE.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2022

Volume

36

Issue

3

Start / End Page

781 / 790

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Referral and Consultation
  • Palliative Care
  • Neurology & Neurosurgery
  • Humans
  • Hispanic or Latino
  • Brain Injuries, Traumatic
  • 4205 Nursing
  • 3209 Neurosciences
  • 3202 Clinical sciences
 

Citation

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Chicago
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Williamson, T. L., Adil, S. M., Shalita, C., Charalambous, L. T., Mitchell, T., Yang, Z., … Komisarow, J. M. (2022). Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization? Neurocrit Care, 36(3), 781–790. https://doi.org/10.1007/s12028-021-01366-2
Williamson, Theresa L., Syed M. Adil, Chidyaonga Shalita, Lefko T. Charalambous, Taylor Mitchell, Zidanyue Yang, Beth A. Parente, et al. “Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?Neurocrit Care 36, no. 3 (June 2022): 781–90. https://doi.org/10.1007/s12028-021-01366-2.
Williamson TL, Adil SM, Shalita C, Charalambous LT, Mitchell T, Yang Z, et al. Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization? Neurocrit Care. 2022 Jun;36(3):781–90.
Williamson, Theresa L., et al. “Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?Neurocrit Care, vol. 36, no. 3, June 2022, pp. 781–90. Pubmed, doi:10.1007/s12028-021-01366-2.
Williamson TL, Adil SM, Shalita C, Charalambous LT, Mitchell T, Yang Z, Parente BA, Lee H-J, Ubel PA, Lemmon ME, Galanos AN, Lad SP, Komisarow JM. Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization? Neurocrit Care. 2022 Jun;36(3):781–790.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2022

Volume

36

Issue

3

Start / End Page

781 / 790

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Referral and Consultation
  • Palliative Care
  • Neurology & Neurosurgery
  • Humans
  • Hispanic or Latino
  • Brain Injuries, Traumatic
  • 4205 Nursing
  • 3209 Neurosciences
  • 3202 Clinical sciences