Background: Patients with stroke have a high risk of death, physical and cognitive impairments and therefore have a high degree of palliative care (PC) needs. The goal of this study is to explore the prevalence of and associations with PC consultation in stroke patients across the country.
Methods: Using the 2010-2012 Nationwide Inpatient Sample database, we reviewed all patients discharged with stroke (based on ICD-9 codes) from 2010-2012. Strokes were sub-classified as ischemic, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). We collected information on demographics, outcome and presence of a “Palliative Care encounter” as defined by the ICD-9 code V66.7.
Results: Overall, there were 395,411 stroke patients with a mean age of 70.11 (SD 16), 52% were female and 69% white. The majority of patients had ischemic strokes (86%) followed by ICH (10%) and SAH (4%). A PC encounter was found in 24,642 patients (6.2%) and was more common in patients with older age, hemorrhagic stroke types, those discharged from larger hospitals and in more recent years (all p<0.05). Higher rate of PC encounters was found for women (OR 1.23, 95% CI 1.19-1.26). Blacks and Hawaiian/Pacific Islanders had less use of PC than whites (all p <0.05). About 9% of patients died in hospital, of which 38% received a PC encounter.
Conclusions: PC encounters are becoming more common for stroke patients, especially in larger hospitals and are strongly associated with hospital death (i.e. more common used in more severe strokes). The unequal distribution across age, gender, stroke type and race suggests a need for more standardized methods to identify patient’s need for PC consultation such as validated PC consultation triggers.