Palliative Care in Stroke Patients: Five Years Retrospective Study of Stroke Patients to whom In-Hospital Palliative Care and Support Team Evaluation was Requested
DOI:
https://doi.org/10.24950/rspmi/original/288/3/2018Keywords:
Palliative Care, StrokeAbstract
Introduction: The unique characteristics of a stroke patient, due to the sudden onset of severe functional impairment, as well as prognostic uncertainty, increase the necessity of a timely Palliative Care approach. Our objective was to analyze the profile of stroke patients to whom In-Hospital Palliative Care and Support Team evaluation was requested.
Methods: Retrospective observational study with a sample composed of all patients admitted with primary diagnosis of stroke in a tertiary hospital, with Team evaluation request, over a period of 5 years (2012-2016).
Results: A total of 48 patients were evaluated, with a mean age of 79.6 years (± 13.1), 24 female. There were 41 ischemic strokes, with mean National Institutes of Health Stroke Scale (NIHSS) upon admission of 18.1 (± 6.5), and 7 cerebral hemorrhages. Evaluation requests were aimed at care organization (89.6%) and decision-making (70.8%), and for symptomatic control: respiratory (58.3%), gastrointestinal (31.3%) and uncontrolled pain (25.0%). At the time of the first evaluation, the mean Palliative Performance Scale 12.2 (± 8,1). Dyspnea (52.6%) and bronchorrhea (50.0%) were the most prevalent symptoms and aspiration pneumonitis the
most common complication (67.4%). Opioid treatment was started in 45.7% and antimuscarinic in 34.8%. In-hospital mortality was 72.9% (n = 35), with 71.4% of deaths occurring on the first 30 days post-event.
Discussion and Conclusion: Due to the complexity and prevalence of uncontrolled symptoms in this type of patients, it is clear that acute neurological events often result in severe functional impairment, reducing both quality of life and life expectancy. These are, therefore, unequivocally patients in need of swift access to Palliative Care.
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