The role of palliative care in acute trauma: When is it appropriate?
Advance directive
Medical decision-making
Palliative care
Trauma outcomes
Trauma resuscitation
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
27
03
2020
revised:
21
08
2020
accepted:
04
10
2020
pubmed:
15
10
2020
medline:
7
1
2021
entrez:
14
10
2020
Statut:
ppublish
Résumé
We hypothesized that trauma providers are reticent to consider palliative measures in acute trauma care. An electronic survey based on four patient scenarios with identical vital signs and serious blunt injuries, but differing ages and frailty scores was sent to WTA and EAST members. 509 (24%) providers completed the survey. Providers supported early transition to comfort care in 85% old-frail, 53% old-fit, 77% young-frail, and 30% young-fit patients. Providers were more likely to transition frail vs. fit patients with (OR = 4.8 [3.8-6.3], p < 0.001) or without (OR = 16.7 [12.5-25.0], p < 0.001) an advanced directive (AD) and more likely to transition old vs. young patients with (OR = 2.0 [1.6-2.6], p < 0.001) or without (OR = 4.2 [2.8-5.0], p < 0.001) an AD. In specific clinical situations, there was wide acceptance among trauma providers for the early institution of palliative measures. Provider decision-making was primarily based on patient frailty and age. ADs were helpful for fit or young patients. Provider demographics did not impact decision-making.
Identifiants
pubmed: 33051066
pii: S0002-9610(20)30613-9
doi: 10.1016/j.amjsurg.2020.10.002
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1456-1461Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.