Background and Purpose: Palliative care (PC) should be an essential component of stroke care, particularly in patients with severe strokes given their poor prognosis and symptom burden. Despite the potential benefits of PC, a recent AHA scientific statement found that PC use in stroke was understudied and poorly understood.
Methods: We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from 3/14-4/15. Demographic and clinical data were collected. We compared the proportion of patients that received an inpatient PC consult to the proportion of patients with a discharge modified Rankin scale (mRS) score of 4-6 (unable to walk without assistance and unable to attend to own bodily needs without assistance) by NIHSS score on admission.
Results: Of the 776 ischemic stroke patients admitted to our CSC, only 6% received a palliative care consult. Even among the 254 patients discharged with a mRS of 4-6, only 16% received an PC consult. Figure 1 displays discharge mRS 4-6 and PC consult proportions by NIHSS severity. Patients that received a PC consult were older (median age 75 vs. 65, p<0.001), had more severe strokes (median NIHSS score 17 vs. 5, p<0.001), and more inpatient complications (56.5% vs. 21.8%, p<0.001). On average, PC consults occurred 3.5 days after admission (IQR 2,9). Of the 43 patients who received a PC consult, 78.3% had “do not resuscitate/do not intubate” (DNR/DNI) orders prior to the PC consult as compared to 95.7% after. Before the PC consult, 30.4% had “comfort care” (CC) orders. After the consult, the proportion with CC orders nearly doubled (58.7%).
Conclusions: Our observations suggest that PC may be underutilized in ischemic stroke patients, particularly in those who may benefit from it the most. PC has great potential to diminish suffering through physical and psychological symptom management. Providers should at least consider PC consults for hospitalized stroke patients.