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01-02-2021 | Stroke | Original Article - Neurosurgery general

Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort analysis

Authors: Joseph R. Linzey, Rachel Foshee, Sudharsan Srinivasan, Arjun R. Adapa, Meghan L. Wind, Carina Brake, Badih Junior Daou, Kyle Sheehan, Thomas C. Schermerhorn, Teresa L. Jacobs, Aditya S. Pandey

Published in: Acta Neurochirurgica | Issue 2/2021

Abstract

Background

Given the serious nature of many neurosurgical pathologies, it is common for hospitalized patients to elect comfort care (CC) over aggressive treatment. Few studies have evaluated the incidence and risk factors of CC trends in patients admitted for neurosurgical emergencies.

Objectives

To analyze all neurosurgical patients admitted to a tertiary care academic referral center via the emergency department (ED) to determine incidence and characteristics of those who initiated CC measures during their initial hospital admission.

Methods

We performed a prospective, cohort analysis of all consecutive adult patients admitted to the neurosurgical service via the ED between October 2018 and May 2019. The primary outcome was the initiation of CC measures during the patient’s hospital admission. CC was defined as cessation of life-sustaining measures and a shift in focus to maintaining the comfort and dignity of the patient.

Results

Of the 428 patients admitted during the 7-month period, 29 (6.8%) initiated CC measures within 4.0 ± 4.0 days of admission. Patients who entered CC were significantly more likely to have a medical history of cerebrovascular disease (58.6% vs. 33.3%, p = 0.006), dementia (17.2% vs. 1.5%, p = 0.0004), or cancer with metastatic disease (24.1% vs. 7.0%, p = 0.001). Patients with a presenting pathology associated with cerebrovascular disease were significantly more likely to initiate CC (62.1% vs. 35.3, p = 0.04). Patients who underwent emergent surgery were significantly more likely to enter CC compared with those who had elective surgery (80.0% vs. 42.7%, p = 0.02). Only 10 of the 29 (34.5%) patients who initiated CC underwent a neurosurgical operation (p = 0.002). Twenty of the 29 (69.0%) patients died within 0.8 ± 0.8 days after the initiation of CC measures.

Conclusion

CC measures were initiated in 6.8% of patients admitted to the neurosurgical service via the ED, with the majority of patients entering CC before an operation and presenting with a cerebrovascular pathology.

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Title: Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort analysis
Authors: Joseph R. Linzey
Rachel Foshee
Sudharsan Srinivasan
Arjun R. Adapa
Meghan L. Wind
Carina Brake
Badih Junior Daou
Kyle Sheehan
Thomas C. Schermerhorn
Teresa L. Jacobs
Aditya S. Pandey
Publication date: 01-02-2021
Publisher: Springer Vienna
Keywords: Stroke
Care
Pathology
Thrombectomy
Published in: Acta Neurochirurgica / Issue 2/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04534-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Neurosurgical patients admitted via the emergency department initiating comfort care measures: a prospective cohort analysis

Abstract

Background

Objectives

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusion

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