Comfort care in trauma patients without severe head injury: In-hospital complications as a trigger for goals of care discussions.
Injury
; 50(5): 1064-1067, 2019 May.
Article
em En
| MEDLINE
| ID: mdl-30745124
ABSTRACT
INTRODUCTION:
Many injured patients or their families make the difficult decision to withdraw life-sustaining therapies (WLST) following severe injury. While this population has been studied in the setting of severe traumatic brain injury (TBI), little is known about patients who undergo WLST without TBI. We sought to describe patients who may benefit from early involvement of end-of-life resources.METHODS:
Trauma Quality Improvement Program (2013-2014) patients who underwent WLST were identified. WLST patients were compared to those who died with full supportive care (FSC). Patients were excluded for death within 24 h of admission, or head AIS > 3. Intergroup comparisons were by student's t tests or Wilcoxon rank sum tests; significance for p < 0.05.RESULTS:
We identified 3471 total injured patients without major TBI who died > 24 h after admission. Of these death after WLST occurred in 2301 (66% of total). This group had a mean age of 66.8 years; 35.7% were women, and 95.4% sustained blunt injury. WLST patients had a higher ISS (21.6 vs. 12.5, p = 0.001), more in-hospital complications (71.4% vs. 41.6%, p = < 0.0001), and a longer ICU length of stay (8.9 days vs. 7.5 days, p = <0.0001) compared to patients who died with FSC.CONCLUSION:
WLST occurs in two-thirds of injured patients without severe TBI who die in the hospital. In-hospital complications are more frequent in this patient group than those who die with FSC. Early palliative care consultation may improve patient and family satisfaction after acute injury when the timeframe to leverage such services is significantly condensed.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Planejamento de Assistência ao Paciente
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Ferimentos e Lesões
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Cuidados Críticos
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Suspensão de Tratamento
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Conforto do Paciente
Tipo de estudo:
Observational_studies
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Prognostic_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Injury
Ano de publicação:
2019
Tipo de documento:
Article