Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units
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ORIGINAL ARTICLE
Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units Claire J. Creutzfeldt1,2 • Hannah Wunsch3,4,5 • J. Randall Curtis2,6 May Hua5
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Published online: 5 May 2015 Ó Springer Science+Business Media New York 2015
Abstract Background Palliative care needs among patients in the neurological intensive care unit (neuroICU) are poorly characterized. Our aim was to explore the prevalence and type of potential palliative care consultation triggers in neuroICUs. Methods We conducted a retrospective cohort study of neuroICU admissions in Project IMPACT from 2001 to 2008. We assessed the prevalence of neuroICU admissions meeting one or more of five validated palliative care consultation triggers and compared the percentage of admissions meeting these triggers in other ICUs from the same hospitals. Results Among 1268 admissions to 2 neuroICUs, 200 (15.8 %) met one or more triggers for palliative care
Electronic supplementary material The online version of this article (doi:10.1007/s12028-015-0143-8) contains supplementary material, which is available to authorized users. & Claire J. Creutzfeldt [email protected]
consultation. Among 13,694 admissions to non-neuroICUs in the same hospitals, 1909 (13.9 %) met one or more palliative care triggers (p = 0.44). The most common trigger in the neuroICU was intracerebral hemorrhage with mechanical ventilation (n = 92; 7.3 %). The most common trigger in non-neuroICUs was ICU admission following C10-day hospital stay (n = 805; 5.9 %). Although ICU mortality was not significantly higher in neuroICU vs. non-neuroICU patients meeting triggers (23.4 vs 19.9 %, p = 0.46), neuroICU patients were significantly more likely to have withdrawal of life-sustaining therapies (19.4 vs 8.0 %, p < 0.001). Conclusions Among neuroICU patients, 15.8 % met triggers for palliative care consultation. Although prevalence of admissions meeting any trigger was similar amongst all ICUs, neuroICU admissions met different types of triggers and were more likely to have withdrawal of life-sustaining therapy. These data suggest that palliative care needs are common among neuroICU patients and discussions with patients and families regarding limitation of life-sustaining therapy may differ in this setting.
1
Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA
Keywords Palliative care Neuro-critical care End-of-life care Severe acute brain injury
2
Cambia UW Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA, USA
Introduction
3
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
4
Department of Anesthesia, University of Toronto, Toronto, ON, Canada
5
Department of Anesthesiology, Columbia University, New York, NY, USA
6
Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
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