Care intensity associated with sociodemographic factors without influencing inpatient mortality for patients with severe traumatic brain injury receiving palliative care

Background: Severe traumatic brain injury (TBI) is associated with significant uncertainty. Palliative care consultation (PCC) may help establish care goals, but little is known about variations in pre-PCC severe TBI care patterns and subsequent outcomes. Our objective was to identify factors associated with pre-PCC care intensity after severe TBI and care intensity's associations with inpatient mortality. Methods: Patients with non-penetrating severe (presenting Glasgow Coma Scale [GCS] ≤ 8) TBI, neurosurgery consultation, and PCC were retrospectively identified. Pre-PCC care intensity was operationalized via Therapy Intensity Level (TIL) scores. An adjusted multivariable linear regression model was constructed to determine associations between sociodemographic factors and pre-PCC TIL. We then employed multivariable logistic regression and propensity score matching to investigate associations of pre-PCC care intensity with inpatient mortality. Results: Sixty-seven patients with severe TBI were included (median age, 70 years; median presenting GCS, 6). Most (N = 37, 55 %) experienced inpatient mortality. In the multivariable linear model, older age was associated with lower pre-PCC TIL scores (β = -0.20; P < 0.001) while Black race was associated with higher scores (β = 3.0; P = 0.03). The multivariable logistic regression model revealed no association between pre-PCC TIL scores and inpatient mortality (P = 0.38). Propensity score matching on age, presenting GCS, and midline shift on initial CT across the median pre-PCC TIL score revealed no significant difference in rates of inpatient mortality between equal groups of 11 patients (P = 0.63). Conclusion: Older age was associated with lower pre-PCC care intensity after severe TBI, while Black race was associated with increased care intensity. However, pre-PCC care intensity was not associated with inpatient mortality. These findings inform discussions between neurosurgeons, patients, and families with regards to care intensity prior to consulting palliative services.