title: Palliative care consultations in hospitalized stroke patients.
abstract: OBJECTIVE
  To determine the pattern and characteristics of palliative care (PC) consultations in patients with stroke and compare them with the characteristics of nonstroke consultations.
  
  
  METHODS
  The palliative care program at Strong Memorial Hospital (SMH) was established in October 2001. SMH is a 765-bed academic medical center with approximately 38,000 discharges. For each consult from 2005 to 2007, we collected demographic, clinical, and service-related information. We explored similarities and differences in patients with different types of stroke, including patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hematoma. In addition, we compared these data to the nonstroke patients who had a palliative care consultation during the same time period.
  
  
  RESULTS
  Over the 3-year period from 2005 to 2007, there were a total of 101 consultations in patients with stroke (6.3% of all PC consultations). Of the 101 consultations, 31 were in patients with ischemic stroke, 26 in patients with intracerebral hemorrhage, 30 in patients with subarachnoid hemorrhage, and 14 in patients with subdural hematoma. Patients with stroke who had a PC consult were more functionally impaired, less likely to have capacity, more likely to die in the hospital, and to have fewer traditional symptom burdens than other common diagnoses seen on the PC consultation service. The most common trajectory to death was withdrawal of mechanical ventilation, but varied by type of stroke. Common treatments negotiated in these consultations included mechanical ventilation, artificial nutrition, tracheostomy, and less likely antibiobics, intravenous fluids, and various neurosurgical procedures.
  
  
  CONCLUSIONS
  Patients with stroke are a common diagnosis seen on an inpatient palliative care consult service. Each stroke type represents patients with potentially distinct palliative care needs.
authors.affiliation: Department of Neurology, Division of Palliative Care, University of Rochester Medical Center, Rochester, New York 14642, USA. robert_holloway@urmc.rochester.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
authors.forename: Susan
authors.initials: S
authors.lastname: Ladwig
authors.forename: Jessica
authors.initials: J
authors.lastname: Robb
authors.forename: Adam
authors.initials: A
authors.lastname: Kelly
authors.forename: Eric
authors.initials: E
authors.lastname: Nielsen
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Quill
mesh_terms: D000368:Aged; D003142:Communication; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009518:New York; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D020521:Stroke
references.citation: Neurology. 1999 May 12;52(8):1602-9
references.pmid: 10331685
references.citation: Neurology. 2007 May 15;68(20):1651-7
references.pmid: 17502545
references.citation: Eur J Neurol. 2008 Dec;15(12):1265-72
references.pmid: 19049542
references.citation: Neurology. 2001 Jul 24;57(2):305-14
references.pmid: 11468317
references.citation: J Palliat Care. 1996 Spring;12(1):5-11
references.pmid: 8857241
references.citation: J Palliat Med. 2007 Feb;10(1):111-7
references.pmid: 17298259
references.citation: J Palliat Med. 2008 Nov;11(9):1249-57
references.pmid: 19021489
references.citation: Palliat Med. 2007 Jun;21(4):323-31
references.pmid: 17656409
references.citation: J Palliat Med. 2002 Feb;5(1):93-100
references.pmid: 11839231
references.citation: Stroke. 1997 Oct;28(10):1883-7
references.pmid: 9341689
references.citation: Palliat Med. 2008 Jan;22(1):95-6
references.pmid: 18216085
references.citation: Crit Care Med. 2001 Sep;29(9):1792-7
references.pmid: 11546988
references.citation: N Engl J Med. 2003 Sep 18;349(12):1123-32
references.pmid: 13679526
references.citation: N Engl J Med. 2003 Aug 14;349(7):667-74
references.pmid: 12917304
references.citation: Stroke. 2005 Aug;36(8):1776-81
references.pmid: 16020772
references.citation: J Palliat Med. 2008 Dec;11(10):1336-9
references.pmid: 19115894
references.citation: Stroke. 2003 Sep;34(9):2109-12
references.pmid: 12881608
references.citation: Neurology. 2001 Mar 27;56(6):766-72
references.pmid: 11274312
references.citation: Neurology. 1997 Sep;49(3):660-4
references.pmid: 9305319