Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: Insights from a Level 1 trauma center

We identified factors and outcomes associated with inpatient palliative care (PC) consultation, stratified into early and late timing, for patients over age 65 with traumatic brain injuries (TBI). Patients over age 65 presenting to a single institution with TBI and intracranial hemorrhage from January 2013-September 2020 were included. Patient demographics and various outcomes were analyzed. Inpatient PC consultation was uncommon (4 % out of 576 patients). Characteristics associated with likelihood of consultation were severe TBI (OR symbolscript 5.030, 95 % CI 1.096-23.082, p symbolscript and pre-existing dementia (OR symbolscript 6.577, 95 % CI 1.726-25.073, p symbolscript Average consultation timing was 8.6 (standard deviation symbolscript 7.0) days. Patients with PC consults had longer overall (p symbolscript and intensive care unit (ICU) length of stays (LOS) (p <.0001), more days intubated (p <.0001) and higher costs (p symbolscript although those with earlier-than-average PC consultation had shorter overall (p symbolscript and ICU (p symbolscript LOS as well as fewer ventilator days (p symbolscript and lower costs (p symbolscript Older patients with TBI are more likely to receive PC based on pre-existing dementia and severe TBI. Patients with PC consultations had worse LOS and higher costs. However, these effects were mitigated by earlier PC involvement. Our study emphasizes the need for timely PC consultation in a vulnerable patient population.