An Objective Trigger for Early Palliative Care in Severely Injured Trauma Patients

Area of Science:

• Trauma surgery
• Palliative care
• Critical care medicine

Background:

• Early palliative care is crucial for severely injured patients facing poor outcomes.
• Current guidelines lack objective measures for initiating palliative care discussions.
• This study sought objective criteria for identifying patients at risk for possible value-incongruent outcomes (pVIOs).

Purpose of the Study:

• To develop objective criteria for early palliative care initiation in trauma patients.
• To identify predictors of possible value-incongruent outcomes (pVIOs) in trauma intensive care unit patients.
• To establish evidence-based triggers for palliative care discussions.

Main Methods:

• Retrospective cohort study of adult trauma intensive care unit patients (2017-2021).
• Analysis of injury and patient characteristics to identify independent predictors of pVIOs.
• Development and validation of predictive models for different age groups.

Main Results:

• 35.7% of patients experienced a pVIO.
• In patients ≤50 years, Glasgow Coma Scale score on postinjury day 3 (GCS_PID3) predicted pVIOs (AUC=0.88).
• In patients >50 years, age, GCS_PID3, anticoagulation, and comorbidities predicted pVIOs (AUC=0.77).

Conclusions:

• GCS_PID3 ≤11 on postinjury day 3 is an accurate objective trigger for early palliative care discussions in trauma patients ≤50 years.
• A predictive model for patients >50 years, while less precise, represents the best objective criterion currently available.
• These findings support the integration of objective measures into palliative care guidelines for trauma survivors.