Palliative care consultations in hospitalized stroke patients.
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.
Holloway
Robert G
RG
Department of Neurology, Division of Palliative Care, University of Rochester Medical Center, Rochester, New York 14642, USA. robert_holloway@urmc.rochester.edu
Ladwig
Susan
S
Robb
Jessica
J
Kelly
Adam
A
Nielsen
Eric
E
Quill
Timothy E
TE
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
Neurology. 1999 May 12;52(8):1602-9
10331685
Neurology. 2007 May 15;68(20):1651-7
17502545
Eur J Neurol. 2008 Dec;15(12):1265-72
19049542
Neurology. 2001 Jul 24;57(2):305-14
11468317
J Palliat Care. 1996 Spring;12(1):5-11
8857241
J Palliat Med. 2007 Feb;10(1):111-7
17298259
J Palliat Med. 2008 Nov;11(9):1249-57
19021489
Palliat Med. 2007 Jun;21(4):323-31
17656409
J Palliat Med. 2002 Feb;5(1):93-100
11839231
Stroke. 1997 Oct;28(10):1883-7
9341689
Palliat Med. 2008 Jan;22(1):95-6
18216085
Crit Care Med. 2001 Sep;29(9):1792-7
11546988
N Engl J Med. 2003 Sep 18;349(12):1123-32
13679526
N Engl J Med. 2003 Aug 14;349(7):667-74
12917304
Stroke. 2005 Aug;36(8):1776-81
16020772
J Palliat Med. 2008 Dec;11(10):1336-9
19115894
Stroke. 2003 Sep;34(9):2109-12
12881608
Neurology. 2001 Mar 27;56(6):766-72
11274312
Neurology. 1997 Sep;49(3):660-4
9305319