Palliative care consultation in patients with bacteremia.

BACKGROUND

Palliative care consultation has shown benefits across a wide spectrum of diseases, but the utility in patients with bacteremia remains unclear despite its high mortality.

AIM

To examine the frequency of palliative care consultation and factors associated with palliative care consult in bacteremia patients in the United States.

DESIGN

A population-based retrospective analysis using the Nationwide Inpatient Sample database in 2014, compiled by the Healthcare Costs and Utilization Project of the Agency for Healthcare Research and Quality.

SETTING/SUBJECTS: All inpatients with a discharge diagnosis of bacteremia (ICD-9-CM codes; 038.11 and 038.12).

MEASUREMENTS

Palliative care consultation was identified using ICD-9-CM code V66.7. Patients' baseline characteristics and outcomes were compared between those with and without palliative care consult.

RESULTS

A total of 111,320 bacteremia admissions were identified in 2014. Palliative care consult was observed in 8140 admissions (7.3%). Palliative care consultation was associated with advanced age, white race, comorbidities, higher income, teaching/urban hospitals, Midwest region, Methicillin-resistant bacteremia and the lack of echocardiogram. Palliative care consult was also associated with shorter but more expensive hospitalizations. Crude mortality was 53% (4314/8140) among admissions with palliative care consult and 8% (8357/10,3180) among those without palliative care consult ( < 0.001).

CONCLUSIONS

Palliative care consultation was infrequent during the management of bacteremia, and a substantial number of patients died during their hospitalizations without palliative care consult. Given the reported benefit in other medical conditions, palliative care consultation may have a role in bacteremia. Selecting patients who may benefit the most should be explored.