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Multicenter Study
. 2022 May;63(5):721-728.
doi: 10.1016/j.jpainsymman.2021.12.032. Epub 2022 Jan 4.

Palliative and End-of-Life Care After Severe Stroke

Amber R Comer  1 , Linda S Williams  2 , Stephanie Bartlett  3 , Lynn D'Cruz  3 , Katlyn Endris  3 , McKenzie Marchand  3 , Isabel Zepeda  3 , Sumeet Toor  4 , Carly Waite  3 , Areeba Jawed  5 , Robert Holloway  6 , Claire J Creutzfeldt  7 , James E Slaven  4 , Alexia M Torke  8
Affiliations
Multicenter Study

Palliative and End-of-Life Care After Severe Stroke

Amber R Comer et al. J Pain Symptom Manage. 2022 May.

Abstract

Background and objectives: The distinct illness trajectory after acute ischemic stroke demands a better understanding of the utilization of palliative care consultations (PCC) for this patient cohort. This study sought to determine the prevalence, predictors, and outcomes associated with PCC for patients hospitalized with severe ischemic stroke.

Methods: This multicenter cohort study was conducted at four hospitals (2 comprehensive and 2 primary stroke centers) between January, 2016 and December, 2019. We included all patients with a discharge diagnosis of ischemic stroke and an initial National Institutes of Health Stroke Scale (NIHSS) of 10 or greater. We compared patient sociodemographic, clinical and care characteristics as well as hospital outcomes between patients who did and did not receive PCC.

Results: The study included 1297 patients hospitalized with severe ischemic stroke. PCC occurred for 20% of all patients and this proportion varied across institutions from 11.9% to 43%. Less than half (43%) of patients who died in the hospital. In multivaraible analysis, PCC was less likely in female patients (OR .76, 95% CI .59, .99, P=0.04) but more likely in patients with higher NIHSS (OR1.95, 95% CI 1,13, 3.37, P=0.02). Patients with PCC had higher rates of moving to a plan focused on comfort measures (CMO) (P<0.01) and removal of artificial nutrition as part of a move to CMO (P<0.01). In a sub analysis of patients who died in the hospital and received PCC, patients who died on or before hospital day 3 were less likely to receive PCC than patients who died on or after hospital day 4 (24% v. 51%) (P=<0.01).

Conclusions: Most patients with severe stroke do not receive PCC, even among those who experience in-hospital death. The results of this study indicate there are missed opportunities for PCC to help reduce suffering after severe stroke.

Keywords: Palliative Care; end-of-life; stroke.

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Figures

Figure 1.
Figure 1.
Day of initial palliative care consultation and length of Hospital stay
See this image and copyright information in PMC

References

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