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OBJECTIVE: Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of sTBI patients who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare healthcare resource utilization (HCRU) between patients with or without PCEs. DESIGN: Retrospective cohort study. SETTING, PARTICIPANTS, AND INTERVENTION: The National Inpatient Sample (NIS) database was queried for patients age ≥ 18 and a diagnosis of sTBI using International Classification of Diseases, 9th Revision (ICD-9) codes. PCEs were defined using ICD-9 code V66.7 and trended from 2001 to 2015. To assess factors associated with PCE in sTBI patients, we performed unweighted generalized estimating equations regression. PCE association with decision making was modeled via its effect on rate of percutaneous endoscopic gastrostomy (PEG) tube placement. To quantify differences in PCE-related decisions by race, race was modeled as an effect modifier. MEASUREMENTS AND MAIN RESULTS: From 2001 to 2015, the proportion of palliative care usage in sTBI patients increased from 1.5% to 36.3%, with 41.6% of white versus 22.3% of black and 25% of Hispanic sTBI patients having a palliative care consultation in 2015. From 2008 to 2015, we identified 17,673 sTBI admissions. White and affluent patients were more likely to have a PCE than Black and Hispanic and low SES patients. Across all races, patients receiving a PCE resulted in a lower rate of PEG tube placement; however, white patients exhibited a larger reduction of PEG tube placement versus Black patients. Patients using palliative care had lower total hospital costs (median $16,368 versus $26,442). CONCLUSIONS: Palliative care usage for sTBI has increased dramatically this century, and it reduces resource utilization. This is true across races, however, its usage rate and associated effect on decision-making are race-dependent, with white patients receiving more PCE and being more likely to decline a PEG tube if they have had a PCE. |
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