Abstract
Abstract INTRODUCTION Over 2.8 million people suffer traumatic brain injuries (TBI) annually in the United States (US), leading to 282,000 hospitalizations (2013).1 Palliative care (PC) aims to improve quality of life via optimizing symptom management and/or discussing hospice care. As knowledge of PC’s beneficial role in critically-ill patients grows, there is a need to evaluate the current trends in PC delivery in severe TBI.2 METHODS We queried the National Inpatient Sample database for patients ≥18 years old with a primary diagnosis of any TBI and then specifically severe TBI. We identified the PC subgroup using ICD-9 code V66.7 and tracked proportions from 2001 to September 2015. Demographic and clinical differences were compared between patients with and without PC encounters beginning in 2008. RESULTS We identified 35,456 severe TBI patients from 2001–2015. The proportion receiving PC increased from 1.5% to 34.58% from 2001 to 2015, with a rapid increase starting in 2008. Compared to the No PC group, the PC group had more patients who were older (median 70 years vs. 40 years), female (37.6% vs 27.6%), white (69.5% vs 59.3%), and had a median household income in the bottom 50% (44.5% vs 40.0%). The PC group had a higher rate of subdural/epidural hemorrhage (36.7% vs 22.9%), but groups were comparable in injury severity scores (mean 21.2 vs 22.2) and Elixhauser comorbidity indexes (mean 6.6 vs 6.7). CONCLUSION From 2001 to 2015, there has been a dramatic increase in the utilization of PC among severe TBI patients, reflecting a change in management style and priorities for these patients. The increase beginning in 2008 coincides with the time PC became recognized as a medical sub-specialty.3 Initial results suggest demographic and clinical differences in patients receiving versus not receiving PC. Future efforts should study the drivers of receiving PC, in addition to changes in quality of life and healthcare resource utilization that stem from increased PC use in severe TBI.
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