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Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?

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Abstract

Background

Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of patients with sTBI who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare health care resource utilization between patients with or without PCEs.

Methods

The National Inpatient Sample database was queried for patients age  ≥  18 who had a diagnosis of sTBI, defined by using International Classification of Diseases, 9th Revision codes. PCEs were defined by using International Classification of Diseases, 9th Revision code V66.7 and trended from 2001 to 2015. To assess factors associated with PCE in patients with sTBI, we performed unweighted generalized estimating equations regression. PCE association with decision making was modeled via its effect on rate of percutaneous endoscopic gastrostomy (PEG) tube placement. To quantify differences in PCE-related decisions by race, race was modeled as an effect modifier.

Results

From 2001 to 2015, the proportion of palliative care usage in patients with sTBI increased from 1.5 to 36.3%, with 41.6% White, 22.3% Black, and 25% Hispanic patients with sTBI having a palliative care consultation in 2015, respectively. From 2008 to 2015, we identified 17,673 sTBI admissions. White and affluent patients were more likely to have a PCE than Black, Hispanic, and low socioeconomic status patients. Across all races, patients receiving a PCE resulted in a lower rate of PEG tube placement; however, White patients exhibited a larger reduction of PEG tube placement than Black patients. Patients using palliative care had lower total hospital costs (median $16,368 vs. $26,442, respectively).

Conclusions

Palliative care usage for sTBI has increased dramatically this century and it reduces resource utilization. This is true across races, however, its usage rate and associated effect on decision making are race-dependent, with White patients receiving more PCE and being more likely to decline the use of a PEG tube if they have had a PCE.

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Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002553. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA

    Theresa L. Williamson, Syed M. Adil, Chidyaonga Shalita, Lefko T. Charalambous, Taylor Mitchell, Beth A. Parente, Shivanand P. Lad & Jordan M. Komisarow

  2. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA

    Zidanyue Yang & Hui-Jie Lee

  3. Fuqua School of Business, Duke University, Durham, NC, 27710, USA

    Peter A. Ubel

  4. Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710, USA

    Monica E. Lemmon

  5. Division of Palliative Care, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA

    Anthony N. Galanos

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  1. Theresa L. Williamson
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  2. Syed M. Adil
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Contributions

TLW, SMA, CS, LTC, H-JL, JMK designed and conceptualized the study, analyzed and interpreted the data, and drafted the manuscript for intellectual content. TM, ZY, ANG analyzed and interpreted the data and drafted the manuscript for intellectual content. BAP, MEL designed and conceptualized the study and edited the manuscript for intellectual content. PAU, SPL designed and conceptualized the study, analyzed and interpreted the data, and edited the manuscript for intellectual content.

Corresponding author

Correspondence to Theresa L. Williamson.

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Conflict of interest

Dr. Lemmon receives salary support from the National Institute of Neurological Disorders and Stroke (K23NS116453). The remaining authors have no conflicts to disclose.

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Williamson, T.L., Adil, S.M., Shalita, C. et al. Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?. Neurocrit Care 36, 781–790 (2022). https://doi.org/10.1007/s12028-021-01366-2

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