Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort anal
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ORIGINAL ARTICLE - NEUROSURGERY GENERAL
Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort analysis Joseph R. Linzey 1 & Rachel Foshee 1 & Sudharsan Srinivasan 2 & Arjun R. Adapa 2 & Meghan L. Wind 1 & Carina Brake 1 & Badih Junior Daou 1 & Kyle Sheehan 1 & Thomas C. Schermerhorn 1 & Teresa L. Jacobs 1 & Aditya S. Pandey 1 Received: 11 June 2020 / Accepted: 11 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Given the serious nature of many neurosurgical pathologies, it is common for hospitalized patients to elect comfort care (CC) over aggressive treatment. Few studies have evaluated the incidence and risk factors of CC trends in patients admitted for neurosurgical emergencies. Objectives To analyze all neurosurgical patients admitted to a tertiary care academic referral center via the emergency department (ED) to determine incidence and characteristics of those who initiated CC measures during their initial hospital admission. Methods We performed a prospective, cohort analysis of all consecutive adult patients admitted to the neurosurgical service via the ED between October 2018 and May 2019. The primary outcome was the initiation of CC measures during the patient’s hospital admission. CC was defined as cessation of life-sustaining measures and a shift in focus to maintaining the comfort and dignity of the patient. Results Of the 428 patients admitted during the 7-month period, 29 (6.8%) initiated CC measures within 4.0 ± 4.0 days of admission. Patients who entered CC were significantly more likely to have a medical history of cerebrovascular disease (58.6% vs. 33.3%, p = 0.006), dementia (17.2% vs. 1.5%, p = 0.0004), or cancer with metastatic disease (24.1% vs. 7.0%, p = 0.001). Patients with a presenting pathology associated with cerebrovascular disease were significantly more likely to initiate CC (62.1% vs. 35.3, p = 0.04). Patients who underwent emergent surgery were significantly more likely to enter CC compared with those who had elective surgery (80.0% vs. 42.7%, p = 0.02). Only 10 of the 29 (34.5%) patients who initiated CC underwent a neurosurgical operation (p = 0.002). Twenty of the 29 (69.0%) patients died within 0.8 ± 0.8 days after the initiation of CC measures. Conclusion CC measures were initiated in 6.8% of patients admitted to the neurosurgical service via the ED, with the majority of patients entering CC before an operation and presenting with a cerebrovascular pathology. Keywords Comfort care . Emergency department . Emergent surgery . End-of-life care . Hospital admission . Stroke
Abbreviations CC Comfort care ED Emergency department
Introduction This article is part of the Topical Collection on Neurosurgery general * Aditya S. Pandey [email protected] 1
Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Center, Ann Arbor, MI 48109-5338, USA
2
University of Michigan Medical School, Ann Arbor, MI, USA
Given the serious, life-alte
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