Professor, Fooyin University, No.151, Chin-Hsueh Rd, Daliao District, Kaohsiung City. China

Background TBI patients who are older than their younger counterparts have greater mortality and morbidity rates. All patients with a serious or terminal illness should receive palliative care (PC). Its use for trauma patients has, however, been unevenly distributed across the country. This study aimed to evaluate the use of PCs and the level of care given to elderly individuals with severe TBI. Despite its benefits, we believed that PC is underutilised. Resources and techniques Patients older than 55 years old with International Classification of Diseases, Ninth Revision codes for traumatic brain injury with loss of consciousness within 24 hours were searched for in the National Inpatient Sample database (2009–2013). PC rate, in-hospital mortality, discharge disposition, and other outcome measures length of stay (LOS), and level of care represented by tracheostomy, percutaneous endoscopic gastrostomy, ventilator use, and either a craniotomy or a craniectomy. Results Among the 5733 patients, 78% passed away at the hospital, with a median length of stay of 1 day, while 85% of the survivors were transferred to other facilities. 35% of people were PCs altogether. Nearly half of deaths within 48 hours of admission and 40% of deaths overall received PC. Compared to 35% of patients who were handled nonoperatively, 26% of those who underwent neurosurgical procedures used PC (P = 0.003). In the total population, PC was linked to less care intensity. When compared to those without PC, survivors experienced significantly shorter LOS. Conclusions Only one-third of elderly patients with severe TBI received PC, despite the significant mortality. PC was linked to less frequent use of life support and less intense nursing care. To close this quality gap and enhance PC in this high-risk population, significant efforts must be made.

Surgical palliative care, Traumatic brain injury, Geriatric trauma, Older patients, Intensity of treatment

Yuien-Chun. Greater National Variability in Palliative Care for Elderly Patients With Severe Traumatic Brain Injury. Insights Journal of Surgery and Clinical Case Reports 2020.