1279: EARLY GOALS-OF-CARE DISCUSSION IN GERIATRIC TRAUMA IS ASSOCIATED WITH INCREASED CODE STATUS CHANGES

Abstract

Introduction: The Trauma Quality Improvement Program guidelines recommend early goals of care (GOC) discussions within 72 hours of admission for geriatric trauma patients. Despite this recommendation family meetings and GOC conversations are often performed in a delayed fashion. We hypothesized that early GOC discussions are associated with higher incidence of goal concordant care manifested as code status changes and implementation of comfort measures only (CMO), as well as shorter hospital length of stay (LOS). Methods: A retrospective chart review was performed on patients aged ≥65 years admitted to Hartford Hospital intensive care units (ICU) with a trauma diagnosis between January 2020 and December 2021. Demographics, timing of GOC discussion, and clinical outcomes were collected. Results: Of 273 identified patients, 78% were male, and median age was 79 years (interquartile range, IQR 71 – 86). Median injury severity scale (ISS) was 13 (IQR 9 – 21), and the most common mechanism of injury was falls (77%). Only 51 (19%) had a GOC discussion documented in the chart within 72 hours of admission. In a logistic regression model adjusting for significant variables, early GOC discussion was associated with higher likelihood for changing code status (adjusted odds ratio, OR 6.0; p< 0.001) and transitioning to CMO (OR 3.4; p=0.008), compared to having GOC discussion after 72 hours or not at all. Among those who had GOC discussion during hospitalization, early GOC discussion was associated with shorter ICU LOS (β=-7.4; p=0.014) and hospital LOS (β=-10.9; p=0.008), adjusting for significant variables identified on the univariable analysis. Patients who had GOC discussion within 72 hours were at significantly lower odds of undergoing invasive procedures (OR 0.41; p=0.02). Conclusions: Early GOC discussion within 72 hours of admission is associated with higher likelihood of code status change and election of CMO in geriatric trauma patients. Interventions to increase adherence to the early GOC meeting recommendation should be emphasized at an institutional level.