Traumatic brain injury（TBI）,which is seen more in young adults,affects both patients and their families.The need for palliative care in TBI and the limits of the care requirement are not clear.The aim of this study ...Traumatic brain injury（TBI）,which is seen more in young adults,affects both patients and their families.The need for palliative care in TBI and the limits of the care requirement are not clear.The aim of this study was to investigate the length of stay in the palliative care center（PCC）,Turkey,the status of patients at discharge,and the need for palliative care in patients with TBI.The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected,including age and gender of patients,the length of stay in PCC,the cause of TBI,diagnosis,Glasgow Coma Scale score,Glas gow Outcome Scale score,Karnofsky Performance Status score,mobilization status,nutrition route（oral,percutaneous endoscopic gastrostomy）,pressure ulcers,and discharge status.These patients were aged 45.4 ± 20.2 years.The median length of stay in the PCC was 34.0 days.These included TBI patients had a Glasg ow Coma Scale score ≤ 8,were not mobilized,received tracheostomy and percutaneous endoscopic gastrostomy nutrition,and had pressure ulcers.No difference was found between those who were discharged to their home or other places（rehabilitation centre,intensive care unit and death） in respect of mobilization,percutaneous endoscopic gastrostomy,tracheostomy and pressure ulcers.TBI patients who were followed up in PCC were determined to be relatively young patients（45.4 ± 20.2 years） with mobilization and nutrition problems and pressure ulcer formation.As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit,provision of palliative care services should be integrated with clinical applications.展开更多
Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be ...Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be safely observed in a non-ICU setting, potentially improving ICU utilization. The purpose of this study was to identify factors that predict which geriatric patients with traumatic brain injury may be admitted to a level of care other than the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7% of subjects, but there was no difference across TBI type. 21.7% of patients developed a ≥2 point decrease in GCS during their hospital stay. Upon discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a single intracranial hemorrhage (ICH) was not significantly associated with outcome, but presence of bilateral or multiple lesions was significantly associated with poor outcome (p = 0.04). Conclusions: Overtriage of patients to an ICU is costly, resource intensive, and avoidable. Here, we suggest a conservative framework to assist the determination of which patients can be safely observed in non-ICU setting. Future studies should determine if this framework is generalizable to the entire geriatric population who present with mTBI.展开更多
文摘Traumatic brain injury（TBI）,which is seen more in young adults,affects both patients and their families.The need for palliative care in TBI and the limits of the care requirement are not clear.The aim of this study was to investigate the length of stay in the palliative care center（PCC）,Turkey,the status of patients at discharge,and the need for palliative care in patients with TBI.The medical records of 49 patients with TBI receiving palliative care in PCC during 2013–2016 were retrospectively collected,including age and gender of patients,the length of stay in PCC,the cause of TBI,diagnosis,Glasgow Coma Scale score,Glas gow Outcome Scale score,Karnofsky Performance Status score,mobilization status,nutrition route（oral,percutaneous endoscopic gastrostomy）,pressure ulcers,and discharge status.These patients were aged 45.4 ± 20.2 years.The median length of stay in the PCC was 34.0 days.These included TBI patients had a Glasg ow Coma Scale score ≤ 8,were not mobilized,received tracheostomy and percutaneous endoscopic gastrostomy nutrition,and had pressure ulcers.No difference was found between those who were discharged to their home or other places（rehabilitation centre,intensive care unit and death） in respect of mobilization,percutaneous endoscopic gastrostomy,tracheostomy and pressure ulcers.TBI patients who were followed up in PCC were determined to be relatively young patients（45.4 ± 20.2 years） with mobilization and nutrition problems and pressure ulcer formation.As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit,provision of palliative care services should be integrated with clinical applications.
文摘Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be safely observed in a non-ICU setting, potentially improving ICU utilization. The purpose of this study was to identify factors that predict which geriatric patients with traumatic brain injury may be admitted to a level of care other than the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7% of subjects, but there was no difference across TBI type. 21.7% of patients developed a ≥2 point decrease in GCS during their hospital stay. Upon discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a single intracranial hemorrhage (ICH) was not significantly associated with outcome, but presence of bilateral or multiple lesions was significantly associated with poor outcome (p = 0.04). Conclusions: Overtriage of patients to an ICU is costly, resource intensive, and avoidable. Here, we suggest a conservative framework to assist the determination of which patients can be safely observed in non-ICU setting. Future studies should determine if this framework is generalizable to the entire geriatric population who present with mTBI.
