Trombley-Brennan Terminal Tissue Injury

 The purpose of our study was to define, describe, compare and contrast the observed skin changes in end of life patients. Our specific aims included: 1) To describe skin changes seen at end of life in patients on the palliative care unit and 2) To identify the relationship between skin changes and time of death in patients on the palliative care unit.

A descriptive study was designed to explain and compare the skin alterations found in patients at the end of life.  Institutional Review Board (IRB) approval was obtained and a retrospective chart review was conducted between January 1, 2009 and June 2011 of the 80 patients who had experienced this alteration in their tissue prior to death. There were 43 (54%) females and 37 (46%) males, and the mean age was 74 (±13.97 SD) with ages ranging from 35 to 95.  Median length of stay (LOS) from admission to death was 11 days (IQR = 24.5 – 6.88 days) and median time from identification of TTI to death was 1 1/2 days  (IQR = 2.75 – 0.50 days) or alternatively 36 hours ( IQR = 66 - 22 hours).    Based on the hypothesis that these injuries are a result of expected skin failure at the end of life, and completely unavoidable, impact on reimbursement issues could be significant. Our hypothesis associates the presentation of terminal tissue injuries as a completely unavoidable occurrence, one that is related to organ failure at the end of life.  It is our hope that the preliminary results of this study, as presented in this work, will serve to encourage further exploration and data collection regarding this phenomenon.