Unmet palliative care needs in elderly trauma patients: can the Palliative Performance Scale help close the gap?
BACKGROUND
The elderly injured have significant palliative care (PC) needs due to increased mortality and poor functional outcomes. We hypothesized the Palliative Performance Scale (PPS) could be predictive of poor outcomes in elderly trauma patients.


METHODS
Retrospective study of trauma patients 55 years or older admitted to the surgical intensive care unit. Using logistic regression, PPS was assessed as a predictor of mortality, Glasgow Outcome Scale, and discharge destination.


RESULTS
Out of 153 patients, 28 died; 28% of the survivors had a Glasgow Outcome Scale 3 or less and 13% were discharged to dependent care. PPS score of 80 or less was an independent predictor of mortality (odds ratio [OR]: 2.97 [1.08 to 8.66]), poor functional outcome (OR: 12.59 [4.81 to 37.07]), and discharge to dependent care (OR: 8.13 [2.64 to 30.09]), yet only 52% of the patients with PPS of 80 or less received PC.


CONCLUSIONS
Admission PPS can predict mortality and poor functional outcomes in elderly trauma patients, and has potential as a trigger for delivery of PC in this vulnerable population.
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Christopher M
CM
McGreevy
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Sarah
S
Bryczkowski
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Sri Ram
SR
Pentakota
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Ana
A
Berlin
Department of Emergency Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Sangeeta
S
Lamba
Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA. Electronic address: mosentac@njms.rutgers.edu.
Anne C
AC
Mosenthal
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D020380:Needs Assessment; D010166:Palliative Care; D010351:Patient Discharge; D063868:Patient Outcome Assessment; D011379:Prognosis; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy
Elderly; Functional outcome; Glasgow Outcome Scale; Palliative care; Palliative performance scale; Trauma