End-of-Life Care in an Acute Neurological Ward: A Retrospective Analysis of Clinical Practices During the Last Week of Life.
Gudrun Jonsdottir, Runar Vilhjalmsson, Valgerdur Sigurdardottir and 3 others
PMID 42636496WHAT IT FOUND
In acute neurological patients, documented end-of-life care was associated with more opioids and benzodiazepines, while lack of documentation was associated with more oxygen, antibiotics, and feeding tubes.
Key findings
01End-of-life treatment directives were documented in 87% of medical records, with the lowest rates in ALS and progressive degenerative disorders.
02Among acute neurological patients, those without documented end-of-life care received more interventions overall, including oxygen therapy (90% vs. 67%), antibiotics (63% vs. 39%), and feeding tube at death (42% vs. 8%).
03Among acute neurological patients, documented end-of-life care was associated with more frequent opioid use (99% vs. 84%) and benzodiazepine use (95% vs. 68%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The diagnostic subgroups were small, especially the progressive disease group, so some differences may have been missed. The data came from clinical records, so interventions or end-of-life decisions that were not documented may have been underreported. Neurological diseases varied widely within each group, so the findings may not apply to every neurological patient. The records spanned 10 years, during which stroke care and end-of-life practice may have changed. The analysis described how often treatments were recorded, not whether each treatment was appropriate for the patient.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not read these intervention counts as proof that documented end-of-life care caused less aggressive treatment. The study was a retrospective record review and did not assess whether each intervention was appropriate, so ward routines, prognosis, and goals of care may explain the differences.