Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?



Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of patients with sTBI who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare health care resource utilization between patients with or without PCEs.


The National Inpatient Sample database was queried for patients age  ≥  18 who had a diagnosis of sTBI, defined by using International Classification of Diseases, 9th Revision codes. PCEs were defined by using International Classification of Diseases, 9th Revision code V66.7 and trended from 2001 to 2015. To assess factors associated with PCE in patients with sTBI, we performed unweighted generalized estimating equations regression. PCE association with decision making was modeled via its effect on rate of percutaneous endoscopic gastrostomy (PEG) tube placement. To quantify differences in PCE-related decisions by race, race was modeled as an effect modifier.


From 2001 to 2015, the proportion of palliative care usage in patients with sTBI increased from 1.5 to 36.3%, with 41.6% White, 22.3% Black, and 25% Hispanic patients with sTBI having a palliative care consultation in 2015, respectively. From 2008 to 2015, we identified 17,673 sTBI admissions. White and affluent patients were more likely to have a PCE than Black, Hispanic, and low socioeconomic status patients. Across all races, patients receiving a PCE resulted in a lower rate of PEG tube placement; however, White patients exhibited a larger reduction of PEG tube placement than Black patients. Patients using palliative care had lower total hospital costs (median $16,368 vs. $26,442, respectively).


Palliative care usage for sTBI has increased dramatically this century and it reduces resource utilization. This is true across races, however, its usage rate and associated effect on decision making are race-dependent, with White patients receiving more PCE and being more likely to decline the use of a PEG tube if they have had a PCE.





Published Version (Please cite this version)


Publication Info

Williamson, Theresa L, Syed M Adil, Chidyaonga Shalita, Lefko T Charalambous, Taylor Mitchell, Zidanyue Yang, Beth A Parente, Hui-Jie Lee, et al. (2022). Palliative Care Consultations in Patients with Severe Traumatic Brain Injury: Who Receives Palliative Care Consultations and What Does that Mean for Utilization?. Neurocritical care, 36(3). pp. 781–790. 10.1007/s12028-021-01366-2 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Lexie Zidanyue Yang

Biostatistician II

Education: Masters Degree, Biostatistics.  Duke University School of Medicine. 2018

Overview: Lexie graduated from the master’s program in biostatistics at Duke in 2018. Over the past five years, she has collaborated with doctors, residents, fellows, and medical students in the Department of Neurosurgery and Pharmacy. Additionally, she is currently working with a faculty member in Surgery to investigate the impact of environmental factors on certain diseases. Lexie has extensive experience in data management with large databases, including MarketScan, HCUP, and CMS Medicare. She has also worked with EHR data and has experience with data extraction from DEDUCE and CRDM. Her statistical interests include longitudinal analysis, mediation analysis, survival analysis and latent class analysis.

Educational Background
Master of Biostatistics
Duke University (Durham, NC, USA) 2016-2018

Bachelor of Science
Mathematics, Statistics
University of Wisconsin-Madison (Madison, WI, USA) 2013-2016
Shandong University (Shandong, China) 2011-2013


Peter A Ubel

Madge and Dennis T. McLawhorn University Distinguished Professor

I am a physician and behavioral scientist at Duke University. My research and writing explores the quirks in human nature that influence our lives — the mixture of rational and irrational forces that affect our health, our happiness and the way our society functions. (What fun would it be to tackle just the easy problems?)

I am currently exploring controversial issues about the role of values and preferences in health care decision making, from decisions at the bedside to policy decisions. I use the tools of decision psychology and behavioral economics to explore topics like informed consent, shared decision making and health care spending. My books include Pricing Life (MIT Press 2000) and Free Market Madness (Harvard Business Press, 2009). My newest book, Critical Decisions (HarperCollins), came out in September of 2012, and explores the challenges of shared decision making between doctors and patients.


Monica Elizabeth Lemmon

Associate Professor of Pediatrics

Anthony Nicholas Galanos

Professor of Medicine

Palliative Care; end of life care; hospitalized elderly were my early career interests.
In the last four years, have been focusing on grief: both personal and professional.  we, at Duke, have done some survey data here in the Medical School and also amongst providers showing both the incidence of grief in learners and the relationship of professional grief to burnout amongst oncology providers.


Shivanand Lad

Professor of Neurosurgery

Dr. Nandan Lad is a neurosurgeon, scientist, and entrepreneur and Professor and Vice Chair of Innovation for Duke Neurosurgery. He is Director of the Functional & Restorative Neuromodulation Program and the Duke NeuroInnovations Program, a systematic approach to innovation to large unmet clinical needs.

He completed his MD and PhD in Biochemistry at Chicago Medical School and his neurosurgical residency training at Stanford with fellowships in both Surgical Innovation and Functional Neurosurgery.  

Neuromodulation; Neurorestoration; Bioengineering; Medical Device Design; Clinical Trials; Data Science; Health Outcomes.


Jordan Komisarow

Assistant Professor of Neurosurgery

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