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Palliative care and aggressive interventions after falling: A Nationwide Inpatient Sample analysis

Published online by Cambridge University Press:  05 March 2021

Vanessa P. Ho Open the ORCID record for Vanessa P. Ho [Opens in a new window] ,
Wyatt P. Bensken Open the ORCID record for Wyatt P. Bensken [Opens in a new window]  and
Siran M. Koroukian Open the ORCID record for Siran M. Koroukian [Opens in a new window]
Vanessa P. Ho*
Affiliation:
Department of Surgery, MetroHealth Medical Center, Cleveland, OH Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
Wyatt P. Bensken
Affiliation:
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
Siran M. Koroukian
Affiliation:
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
*
Author for correspondence: Vanessa P. Ho, Department of Surgery, Division of Trauma, Critical Care, Burn, and Acute Care Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109, USA. E-mail: vho@metrohealth.org
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Abstract

Objective

The purpose of this study is to identify whether there is an opportunity for improvement to provide palliative care services after a serious fall. We hypothesized that (1) palliative care services would be utilized in less than 10% of patients over the age of 65 who fall and (2) more than 20% of patients would receive aggressive life-sustaining treatments (LSTs) prior to death.

Methods

Using the 2017 Nationwide Inpatient Sample, we identified patients who were admitted to the hospital with a fall (ICD-10 W00-W19) and were hospitalized at least two days with valid discharge data. Palliative care services (Z51.5) or LSTs (cardiopulmonary resuscitation, ventilation, reintubation, tracheostomy, feeding tube placement, vasopressors, transfusion, total parenteral nutrition, and hemodialysis) were identified with ICD-10 codes. We examined the use of palliative care or LSTs by discharge destination (home, facility, and death). Logistic regression was used to identify factors associated with palliative care.

Results

In total, 155,241 patients were identified (median 82 years old, interquartile range 74–88); 2.5% died in hospital, and 69.4% were transferred to a facility. Palliative care occurred in 4.5% of patients, and LST occurred in 15.1%. Patients who died were significantly more likely to have had palliative care (50.1% vs. 3.4% of home or facility discharges) and were more likely to have an LST [53.0% vs. 9.8% (home) vs. 15.9% (facility)]. Palliative care was associated with both death [adjusted odds ratio (AOR) 19.84, 95% confidence interval (CI) 18.39–21.41, p < 0.001] and LST (AOR 1.36, 95% CI 1.27–1.46, p < 0.001).

Significance of results

Palliative care is associated with both death and LST, suggesting that physicians use palliative care as a last resort after aggressive measures have been exhausted. Patients who fall would likely benefit from the early use of palliative care to align future goals of care.

Keywords

Geriatric traumaPalliative careTrauma
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 1 , February 2022 , pp. 101 - 106
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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