Division of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, Florida; Division of Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, Florida.
Division of Trauma and Critical Care Services, Delray Medical Center, Delray Beach, Florida; Department of Surgery, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida.
J Surg Res. 2021 Aug;264:149-157. doi: 10.1016/j.jss.2021.02.017. Epub 2021 Apr 5.
Palliative care in trauma patients is still evolving. The goal was to compare characteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric (≥65 y.o.) and non-geriatric trauma patients.
Retrospective study included 432 patients from two level 1 trauma centers who received PCC between December 2012 and January 2019. Non-geriatric (n = 61) and geriatric (n = 371) groups were compared for: mechanism of injury (MOI), Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Score (GCS), Do-Not-Resuscitate (DNR) orders, futile interventions (FI), duration of mechanical ventilation (DMV), ICU admissions, ICU and hospital lengths of stay (ICULOS; HLOS), timing to PCC, and mortality. Further propensity matching (PM) analysis compared 59 non-geriatric to 59 Geriatric patients matched by ISS, GCS, and DNR.
Geriatric patients were older (85.2 versus 49.7), with falls as predominant MOI. Non-geriatric patients comprised 14.1% of all patients with PCC and were more severely injured than Geriatrics: with statistically higher ISS (24.1 versus 18.5), lower RTS (5.4 versus 7.0), GCS (7.1 versus 11.5), with predominant MOI being traffic accidents, all P < 0.01. Non-Geriatrics had more ICU admissions (96.7% versus 88.1%), longer ICULOS (10.2 versus 4.7 days), DMV (11.1 versus 4.1 days), less DNR (57.4% versus 73.9%), higher in-hospital mortality (12.5% versus 2.6%), but double the time admission-PCC (11.3 versus 4.3 days) compared to Geriatrics, all P < 0.04. In PM comparison, despite same injury severity, Non-geriatrics had triple the time to PCC, five times the HLOS of geriatrics, and more FI (25.4% versus 3.4%), all P < 0.001.
PCC remains underutilized in non-geriatric trauma patients. Despite higher injury severity, non-geriatrics received more aggressive treatment, and had three times longer time to PCC, resulting in higher rate of FI than in Geriatrics.
创伤患者的姑息治疗仍在不断发展。本研究旨在比较老年（≥65 岁）和非老年创伤患者的姑息治疗咨询（PCC）的特征、结局、触发因素和时机。
本回顾性研究纳入了 2012 年 12 月至 2019 年 1 月期间在 2 个 1 级创伤中心接受 PCC 的 432 例患者。比较了非老年（n=61）和老年（n=371）患者的损伤机制（MOI）、损伤严重程度评分（ISS）、修订创伤评分（RTS）、格拉斯哥昏迷评分（GCS）、不复苏（DNR）医嘱、无效干预（FI）、机械通气时间（DMV）、重症监护病房（ICU）入住率、ICU 和住院时间（ICULOS；HLOS）、PCC 时间以及死亡率。进一步的倾向评分匹配（PM）分析比较了 59 名非老年患者和 59 名匹配 ISS、GCS 和 DNR 的老年患者。
老年患者年龄较大（85.2 岁 vs. 49.7 岁），以跌倒为主要 MOI。非老年患者占所有接受 PCC 治疗患者的 14.1%，其损伤程度比老年患者更严重：ISS 更高（24.1 岁 vs. 18.5 岁），RTS 更低（5.4 岁 vs. 7.0 岁），GCS 更低（7.1 岁 vs. 11.5 岁），主要 MOI 为交通事故，所有 P<0.01。非老年患者 ICU 入住率更高（96.7% vs. 88.1%），ICULOS 更长（10.2 天 vs. 4.7 天），DMV 更长（11.1 天 vs. 4.1 天），DNR 更少（57.4% vs. 73.9%），院内死亡率更高（12.5% vs. 2.6%），但与老年患者相比，入院-PCC 时间更长（11.3 天 vs. 4.3 天），所有 P<0.04。在 PM 比较中，尽管损伤严重程度相同，非老年患者的 PCC 时间延长了三倍，HLOS 延长了五倍，FI 增加了三倍（25.4% vs. 3.4%），所有 P<0.001。
姑息治疗在非老年创伤患者中仍未得到充分利用。尽管损伤严重程度较高，但非老年患者接受了更积极的治疗，且 PCC 时间延长了三倍，导致 FI 发生率高于老年患者。
