Abstract TP108: Early Palliative Care Consultation In Patients With Disabling Stroke

Stroke, Volume 54, Issue Suppl_1, Page ATP108-ATP108, February 1, 2023. Severe disability and critical illness due to stroke can be burdensome to patients, caregivers, and resource intensive, particularly in the elderly. Management of these patients is multifaceted and includes optimizing quality of life through palliative care (PC). PC in stroke patients can improve comfort while reducing overutilization of resources unlikely to prolong life or contribute meaningful quality. We investigated the impact of early PC involvement in disabled stroke patients, which we defined as NIH Stroke Score ≥ 5 and ICU admission. A screening program was implemented in 2019 at the Loyola University Medical Center for automatic PC consults in disabling stroke (ischemic or hemorrhagic) patients over age 70 or who require a ventilator. We hypothesized that early PC consultation via this protocol reduced resource consumption without compromising patient care. This pilot study gathered data prospectively for patients with a positive screen from 2020 to 2021 (“screening”, n=71), and retrospectively for those who met screening criteria in 2017 and 2018 prior to its application (“control”, n=193). Comparing the screening and control groups, there was no significant difference in age (75.9 ± 2.7 vs 72.1 ± 1.1, p >0.1), NIH stroke score (16.6 ± 0.5 vs 17.5 ± 0.9, p=0.2), stroke type (61% vs 69% ischemic, p >0.2), or proportion who expired (22% vs 18%, p=0.4). However, the screening group had more frequent code status change from full to DNR/DNI (42% versus 19%, p

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Febbraio 2023

Gabapentin Will Not Cure the Opioid Crisis

In JAMA Internal Medicine, Peet and colleagues report remarkable trends in opioid and gabapentin prescribing patterns. Between 2006 and 2018, the total volume of opiate prescriptions initially rose, but began to plateau approximately 10 years ago before falling at the end of the observational period. In parallel, the number of gabapentin prescriptions increased 5-fold. Though the total volume of opioid prescriptions was stable before eventually falling, the number of episodes of overlapping gabapentin and opioid prescriptions more than tripled.

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Febbraio 2023