Early Comfort Care Following Operative Intervention for Traumatic Injury

Abstract

Background Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery. Methods This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives. Charts of all patients who died or who were discharged to hospice were analyzed to determine whether WLST occurred. Statistics included Fisher’s exact test and Mann-Whitney U test. Results Three thousand and twenty-five adult trauma patients received care and 1495 (49.4%) had operations. Thirty (2.0%) patients underwent WLST, 15 (50.0%) of whom died in the hospital and 15 (50.0%) of whom were discharged to hospice. Twenty-six (86.7%) patients had a palliative care consult and 12 (40.0%) had prior advance directives. The most common injuries were femur fractures and subdural hematomas. Adjusting for age, white race, and age-adjusted CCI, femur fracture patients had, on average, 8.8 more hours between presentation and surgery (95% CI 2.1-15.4, P = .01) and 39 fewer hours between surgery and WLST (95% CI −107–29, P = .26) than traumatic brain injury patients. Discussion The short time between surgery and WLST in this cohort of patients may demonstrate that surgery was not aligned with patients’ goals of care. A patient-centered approach that includes surgeon-driven palliative care discussions may help avoid nonbeneficial surgery in the last few days of life.

Curative Effect of Early Full Nursing Combined with Postdischarge Continuation Nursing on Patients after Craniocerebral Trauma

“…The brain tissue damage of the patient causes the nervous system function to be affected, which affects the cognitive ability, motor function, and inconvenience to daily life [ 3 , 4 ]. Early full nursing for some patients with dysfunction is helpful to accelerate the reorganization of central nervous system function and coordinate muscle and limb activities [ 5 , 6 ]. For patients who have not fully recovered their health after being discharged from the hospital, continuation nursing can transfer nursing work from the hospital to the family to meet their nursing needs [ 7 , 8 ].…”

The 2023 WSES guidelines on the management of trauma in elderly and frail patients

“…Therefore the decision depends on type of injury, different religions, decision-maker viewpoint, and institutional resources and results in significant variation after trauma [436]. Palliative care physicians are more familiar and have more training in this complex decision making [437]. Moreover trauma surgeons can identify early patients who could die because of traumatic injuries, but they have the difficulty to estimate long-term outcomes [438].…”

“…Authors reported that controlling for patient characteristics, utilization of palliative care services was associated with increased odds of discharge to hospice In a retrospective study by Hoffman et al, 86.7% of trauma patients who underwent Withdrawal of Life-Sustaining Treatment after surgery received a palliative care consult. However, the short time between surgery and withdrawal of life-sustaining treatments suggested that increase palliative care system before surgery can help in decision-making process to avoid unnecessary surgeries [437].…”

Interventions of Advanced Lung Cancer Patient Receiving Chemotherapy by Computed Tomography Image Information Data Analysis-Based Soothing Care Plans

“…In recent years, palliative care has gradually been welcomed and recognized in the care and treatment of patients, and it is a new concept of nursing. It advocates respecting the wishes of patients, caring for the psychological needs of patients, providing patients with comfortable and humanistic nursing services, meeting the individual needs of patients, and maximizing pain relief [ 4 ]. Palliative care is mainly to maximize the comfort of patients, maintain the dignity of patients, and improve the quality of life of patients.…”