Introduction/Hypothesis: A dramatic change in use of palliative care (PC) has been reported among hospitalized patients with multiple sclerosis (MS), with nearly 30-fold rise between 2009 and 2014 (0.2% vs. 6.1%, respectively) in a national cohort in the United States. However, there are no data on the contemporary patterns of PC utilization among MS patients admitted to ICU.
Methods: The Texas Public Use Data File was used to identify hospitalizations aged ≥18 years with MS (ICD-9 code 340) and those admitted to ICU during 2009-2014. Use of PC was identified by ICD-9 code V66.7. Secular trends of PC utilization among ICU admissions (ICU) were anchored to those without ICU admission (non-ICU) to provide further context. Logistic regression models were used to examine the temporal patterns of PC utilization rates among all ICU and non- ICU hospitalizations & the corresponding terminal hospitalizations.
Results: Among 45,589 MS hospitalizations, 12,916 (28.3%) were admitted to ICU, with PC use reported 412 (0.9%) of all MS hospitalizations (non-ICU, 0.5%; ICU, 1.9%). Hospital mortality was 1.4% (non-ICU, 0.5%; ICU, 3.6%). The following changes in rates of PC utilization were observed between 2009 & 2014, with corresponding odds ratios/year (OR/yr [95% CI]): ICU (all) 1.1% vs. 2.9% (OR/yr 1.24 [1.14-1.34]); non-ICU (all) 0.6% vs. 0.5% (OR/yr 0.98 [0.89-1.07]); ICU (terminal hospitalizations) 21% vs. 34.7% (OR/yr 1.22 [1.07-1.38]); non-ICU (terminal hospitalizations) 31.4% vs. 33.3% (OR/yr 1.03 [0.84-1.25]). Between 2009 & 2014 PC use among all ICU admissions accounted for 98% of the growth in PC use among all MS hospitalizations and PC use among terminal hospitalizations with ICU admission accounted for 100% of the rise in reported PC among all terminal hospitalizations with MS.
Conclusions: The use of PC among MS hospitalizations in Texas remained low, as compared to reported national data. The rise in PC utilization in the present cohort was driven almost exclusively by its increasing use among patients with MS admitted to ICU, both among all hospitalizations and among terminal hospitalizations. Our findings warrant further studies in other states and underscore opportunities for discussions with patients with MS and their surrogates about goals of care during health crises, as well as prior to triage decisions.