End-of-Life Decision-Making for Patients With Geriatric Trauma Cared for in a Trauma Intensive Care Unit

Wooster, Meghan E.; Stassi, Alyssa; Hill, Josh; Kurtz, James; Bonta, Marco; Spalding, M Chance

doi:10.1177/1049909117752670

Cited by 14 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…12,23 Our findings are in accordance with recently published data by Wooster et al that the prehospital presence of a DNR order in geriatric trauma patients was significantly associated with withdrawal of care (WOC), and patients with PCC were 12.4 times more likely to undergo WOC. 24 Limitations of the Study Data were collected from only 2 trauma centers in an area with high prevalence of population with advanced age. The consultative open model was used in both centers which may have resulted in different PCC patterns compared to closed or integrative models of PCC.…”

Section: Analysis Of Dnr In the Pcc Groupmentioning

confidence: 99%

See 1 more Smart Citation

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study

Fokin

Katz

Tymchak

et al. 2020

Am J Hosp Palliat Care

View full text Add to dashboard Cite

Objective: To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes. Methods: Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019. Level 1 trauma centers are designated for admission of the most severe injured patients. Palliative care consultation group of 432 patients who received PCC and were compared to matched control (MC) group of 432 patients without PCC. Propensity matching covariates included Injury Severity Score, mechanism of injury, gender, and hospital length of stay (HLOS). Analysis included patient demographics, injury parameters, intensive care unit (ICU) admissions, ICU length of stay (ICULOS), duration of mechanical ventilation, timing of PCC and DNR, and mortality. Palliative care consultation patients were further analyzed based on DNR status: prehospital DNR, in-hospital DNR, and no DNR (NODNR). Results: Palliative care consultation compared to MC patients were older, predominantly Caucasian, with more frequent traumatic brain injury (TBI), ICU admissions, and mechanical ventilation. The average time to PCC was 5.3 days. Do-not-resuscitate orders were significantly more common in PCC compared to MC group (71.5% vs 11.1%, P < .001). Overall mortality was 90.7% in PCC and 6.0% in MC ( P < .001). In patients with DNR, mortality was 94.2% in PCC and 18.8% in MC. In-hospital DNR-PCC compared to NODNR-PCC patients had shorter ICULOS (5.0 vs 7.3 days, P = .04), HLOS (6.2 vs 13.2 days, P = .006), and time to discharge (1.0 vs 6.3 days, P = .04). Conclusions: Advanced age, DNR order, and TBI were associated with a PCC in trauma patients and resulted in significantly higher mortality in PCC than in MC patients. Combination of DNR and PCC was associated with shorter ICULOS, HLOS, and time from PCC to discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Analysis Of Dnr In the Pcc Groupmentioning

confidence: 99%

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study

Fokin

Katz

Tymchak

et al. 2020

Am J Hosp Palliat Care

View full text Add to dashboard Cite

show abstract

“…There is a clear clinical need to improve our communication regarding goals and wishes; as even in patients with a stated desire to favor quality over quantity of life, preserving quality of life is not reliably honored [ 10 ]. Even in patients with established living wills or advanced directives, fulfillment of end of life wishes in the ICU remains inconsistent [ 11 ]. These data emphasize the imperative to improve the communication between patients, their families, and the care team through an earlier consensus on goals of care (GOC) [ 12 •].…”

Section: Clinical and Research Needmentioning

confidence: 99%

“…As the poor to moderate performance of the “surprise” question in non-cancer diseases demonstrated, established screening systems designed in non-trauma patients have only limited ability to perform well in trauma patients [ 54 ]. Within the trauma population, triggers for consultation are poorly defined, beyond injury severity score and profound neurologic injury in older patients [ 2 , 11 ]. Within the general geriatric trauma population, the Geriatric Trauma Outcomes Score (GTOS) is a validated predictive tool that can provide a reliable estimate of in-hospital mortality risk using data available early in a patient’s hospital course, allowing palliative consultations for the highest risk patients [ 55 – 57 ].…”

Section: Communication In the Trauma/surgical Intensive Care Unitmentioning

confidence: 99%

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

2020

View full text Add to dashboard Cite

Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.

show abstract

“…This requires a gentle and caring approach. Loss of bowel and bladder control is a common problem in the elderly, and can also be distressing and embarrassing for both the patient and the medical personnel; however, it should never interfere with patient care [3].…”

Section: Introductionmentioning

confidence: 99%

Public health impact of osteoporosis in older age

Pawłowski¹,

Goniewicz²,

Goniewicz³

et al. 2018

J Pre Clin Clin Res.

View full text Add to dashboard Cite

The population of elderly people (over 65 years of age) is constantly growing in the majority of western societies. This is due to the advances in medicine and the increasing awareness of healthier lifestyles during the last several decades. It is predicted that by the year 2030 there will be 70.2 million people aged 65 or older. Osteoporosis is the most common type of bone disease. The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause, and a drop in testosterone in men. Women aged over 50 and men aged over 70 have a higher risk for osteoporosis. Osteoporotic fractures are one of the most common causes of disabilities, and are a very costly bureden on the budgets of health care systems in many regions of the world. The fractures are caused especially following low-energy trauma (injury from a small force, e.g. after falling from a height). The most common osteoporotic fractures are: vertebral fractures, fractures of the forearm, proximal end of the femur fractures, and the proximal end of the humerus. Research on the basis of domestic and foreign literature and the results of their observations are presented, and the principles of epidemiology for the identification and treatment of osteoporotic fractures. Consciousness of serious risks related with osteoporotic fractures should lead to implementation and propagating more active preventive activity for patients of old age. According to the WHO, IOF and EFORT, a doctor admitting a patient with an osteoporotic fracture should not only treat the fracture itself, but also implement preventive procedures.

show abstract

End-of-Life Decision-Making for Patients With Geriatric Trauma Cared for in a Trauma Intensive Care Unit

Cited by 14 publications

References 27 publications

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient

Public health impact of osteoporosis in older age

Contact Info

Product

Resources

About