Care intensity associated with sociodemographic factors without influencing inpatient mortality for patients with severe traumatic brain injury receiving palliative care.

BACKGROUND

Severe traumatic brain injury (TBI) is associated with significant uncertainty. Palliative care consultation (PCC) may help establish care goals, but little is known about variations in pre-PCC severe TBI care patterns and subsequent outcomes. Our objective was to identify factors associated with pre-PCC care intensity after severe TBI and care intensity's associations with inpatient mortality.

METHODS

Patients with non-penetrating severe (presenting Glasgow Coma Scale [GCS] ≤ 8) TBI, neurosurgery consultation, and PCC were retrospectively identified. Pre-PCC care intensity was operationalized via Therapy Intensity Level (TIL) scores. An adjusted multivariable linear regression model was constructed to determine associations between sociodemographic factors and pre-PCC TIL. We then employed multivariable logistic regression and propensity score matching to investigate associations of pre-PCC care intensity with inpatient mortality.

RESULTS

Sixty-seven patients with severe TBI were included (median age, 70 years; median presenting GCS, 6). Most (N = 37, 55 %) experienced inpatient mortality. In the multivariable linear model, older age was associated with lower pre-PCC TIL scores (β = -0.20; P < 0.001) while Black race was associated with higher scores (β = 3.0; P = 0.03). The multivariable logistic regression model revealed no association between pre-PCC TIL scores and inpatient mortality (P = 0.38). Propensity score matching on age, presenting GCS, and midline shift on initial CT across the median pre-PCC TIL score revealed no significant difference in rates of inpatient mortality between equal groups of 11 patients (P = 0.63).

CONCLUSION

Older age was associated with lower pre-PCC care intensity after severe TBI, while Black race was associated with increased care intensity. However, pre-PCC care intensity was not associated with inpatient mortality. These findings inform discussions between neurosurgeons, patients, and families with regards to care intensity prior to consulting palliative services.