Unmet palliative care needs in elderly trauma patients: can the Palliative Performance Scale help close the gap?

Background: The elderly injured have significant palliative care (PC) needs due to increased mortality and poor functional outcomes. We hypothesized the Palliative Performance Scale (PPS) could be predictive of poor outcomes in elderly trauma patients.

Methods: Retrospective study of trauma patients 55 years or older admitted to the surgical intensive care unit. Using logistic regression, PPS was assessed as a predictor of mortality, Glasgow Outcome Scale, and discharge destination.

Results: Out of 153 patients, 28 died; 28% of the survivors had a Glasgow Outcome Scale 3 or less and 13% were discharged to dependent care. PPS score of 80 or less was an independent predictor of mortality (odds ratio [OR]: 2.97 [1.08 to 8.66]), poor functional outcome (OR: 12.59 [4.81 to 37.07]), and discharge to dependent care (OR: 8.13 [2.64 to 30.09]), yet only 52% of the patients with PPS of 80 or less received PC.

Conclusions: Admission PPS can predict mortality and poor functional outcomes in elderly trauma patients, and has potential as a trigger for delivery of PC in this vulnerable population.