Abstract
BACKGROUND
Approximately 40% of patients with newly diagnosed brain metastases (BMETs) present to the ED or are admitted to the hospital. The optimal diagnostic and therapeutic care for these patients has not been established.
OBJECTIVE
To map and identify the opportunities to provide value care for patients who come to the ED or are admitted to the hospital with newly diagnosed BMETs.
METHODS
Following quality improvement methodology, we defined the scope of the population to be studied, developed a flowchart, and identified decision points to measure the characteristics and outcomes of patients who come to the ED or are admitted with newly diagnosed BMETs at a tertiary academic center. We abstracted data between 2017 and 2019 including performance status (ECOG, KPS, U-RPA), synchronous/metachronous status, consulting and admitting specialties, diagnostic workup performed, BMETs characteristics on imaging, and acute interventions (surgery, WBRT, and/or GKRS).
RESULTS
We identified 138/339 (40.7%) patients who met eligibility criteria; 101/138 (73.2%) presented via ED; 37/138 (26.8%) were direct admissions. Of the 138 patients, 68 (49.3%) had synchronous BMETs with 66/68 (97.1%) having tissue sampled for pathology (peripheral tissue biopsy and/or BMET surgical resection). In 83/138 (60.1%), an intervention was performed during hospital admission. The median time (h:mm) spent in the ED was 7:16 (Range: 0:58 – 25:35). Of the 101 patients seen in the ED, 96 (95.0%) were admitted. All 12 patients with hydrocephalus received an acute intervention.
CONCLUSION
The lack of clear guidelines for ED evaluation and hospital admission for patients with newly diagnosed BMETs leads to higher admission rates and inpatient resource usage. Analysis of our results will identify interventions that may improve the value of the care provided to this complex patient population.