Adopting the Fourth Pillar of Acute Care Surgery: The Current State of Palliative Medicine in Trauma Care

Purpose of Review Palliative care utilization in trauma care has evolved over time and the current state of integration varies between hospital systems nationwide. As the number of older adults suffering serious traumatic injuries continues to rise, there is a growing need to incorporate palliative care into trauma care. We examine current gaps in surgical palliative care integration and highlight components of effective primary palliative care that trauma surgeons should be familiar with in practice. Recent Findings Although most older trauma patients survive hospitalization, many deaths occur within six months after discharge, making early goals-of-care (GOC) discussions essential. However, palliative care consultation remains significantly underused, occurring in only 2–4% of severely injured trauma cases. The article also notes a major palliative care workforce shortage, which increases the importance of surgeons being comfortable providing primary palliative care. Studies reviewed show mixed adherence to the American College of Surgeons TQIP palliative care guidelines, with some hospitals successfully improving GOC documentation while others saw little change since guideline release. Summary Primary palliative care skills are essential for trauma surgeons, though effective integration into the trauma system has been variable. As the need grows, the specialty palliative care work force cannot keep up with demand, highlighting the need for surgeons to learn and perfect their primary palliative care skills, including communication skills and holistic symptom management. Palliative care should function as a core pillar of trauma care, ensuring dignity, reducing non-beneficial treatments, and improving end-of-life experiences for patients and families.