Palliative delays associated with increased length of stay in older traumatic brain injury patients.

BACKGROUND

Trauma Quality Improvement Program guidelines recommend early goals of care discussions (≤72 hours) for older patients with severe injuries. We sought to characterize palliative interventions (PIs) among older adults with traumatic brain injury (TBI) given the high-risk nature of this population.

METHODS

Patients (55 years or older) with moderate to severe TBI (head Abbreviated Injury Scale score, ≥3) were retrospectively identified at a level I trauma center (2020-2022). Palliative interventions were defined as family meeting, goals of care discussion, or palliative care consult, with early PI occurring ≤72 hours. Regression analyses were used to evaluate effect of PI timing on hospital and intensive care unit length of stay (LOS). Kaplan-Meier analysis was performed to compare survival by PI timing.

RESULTS

Three hundred thirty-seven patients were included, with 25.8% of patients receiving PI, including 98.1% of those who died or entered hospice. Early PI patients were older ( p = 0.011), with higher average Charlson Comorbidity Index ( p = 0.011) and greater injury severity ( p < 0.001). The median hospital LOS for the early PI cohort was 6 days (interquartile range, 3-10 days) versus 15 days (interquartile range, 10-22 days) with late PI. There was no mortality difference between early and late PI ( p = 0.650). Compared with early PI, after adjusting for demographic and clinical characteristics, patients with late PI had longer hospital LOS ( p < 0.001) and longer intensive care unit LOS ( p < 0.001).

CONCLUSIONS

Delayed PI is associated with increased LOS in older TBI patients, with no survival difference compared with early PI. Palliative interventions should be introduced early to reduce morbidity in patients with potential poor prognosis.

LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level II.