BACKGROUND: Despite a well-described association of age and injury with mortality and decreased functional status, inpatient mortality studies have traditionally not included analysis of do not resuscitate (DNR) status. We hypothesized that the increased likelihood of DNR status in older patients alters age-adjusted mortality rates in trauma. METHODS: The trauma registry was queried for adult patients admitted to our Level I trauma center (January 2005-December 2008) and divided into eight age groups by decade. Ages 15-44 years were collapsed because of the lack of variation. We compared age, case fatality rate, and DNR status by univariate analysis and trends by χ (p < 0.05). RESULTS: Of the 15,227 adult patients admitted, 13% were elderly (≥65) and 7% died. DNR status was known in 75% of deaths, and 42% of those had active DNR orders on the chart at time of death. DNR likelihood increased with age (p < 0.05), from 5% to 18%. With DNRs excluded, mortality variability across all ages was markedly diminished (4-7%). CONCLUSION: DNR status among trauma patients varies significantly because of inconsistent implementation and meaning between hospitals, and successive decades are more likely to have an active DNR order at time of death. When DNR patients were excluded from mortality analysis, age was minimally associated with an increased risk of death. The inclusion of DNR patients within mortality studies likely skews those analyses, falsely indicating failed resuscitative efforts rather than humane decisions to limit care after injury.
BACKGROUND: Despite a well-described association of age and injury with mortality and decreased functional status, inpatient mortality studies have traditionally not included analysis of do not resuscitate (DNR) status. We hypothesized that the increased likelihood of DNR status in older patients alters age-adjusted mortality rates in trauma. METHODS: The trauma registry was queried for adult patients admitted to our Level I trauma center (January 2005-December 2008) and divided into eight age groups by decade. Ages 15-44 years were collapsed because of the lack of variation. We compared age, case fatality rate, and DNR status by univariate analysis and trends by χ (p < 0.05). RESULTS: Of the 15,227 adult patients admitted, 13% were elderly (≥65) and 7% died. DNR status was known in 75% of deaths, and 42% of those had active DNR orders on the chart at time of death. DNR likelihood increased with age (p < 0.05), from 5% to 18%. With DNRs excluded, mortality variability across all ages was markedly diminished (4-7%). CONCLUSION: DNR status among traumapatients varies significantly because of inconsistent implementation and meaning between hospitals, and successive decades are more likely to have an active DNR order at time of death. When DNR patients were excluded from mortality analysis, age was minimally associated with an increased risk of death. The inclusion of DNR patients within mortality studies likely skews those analyses, falsely indicating failed resuscitative efforts rather than humane decisions to limit care after injury.
Authors: David G Jacobs; Brian Ray Plaisier; Philip S Barie; Jeffrey S Hammond; Michele R Holevar; Karlene E Sinclair; Thomas M Scalea; Wendy Wahl Journal: J Trauma Date: 2003-02
Authors: Sasha D Adams; Bryan A Cotton; Mary F McGuire; Edmundo Dipasupil; Jeanette M Podbielski; Adrian Zaharia; Drue N Ware; Brijesh S Gill; Rondel Albarado; Rosemary A Kozar; James R Duke; Philip R Adams; Carmel B Dyer; John B Holcomb Journal: J Trauma Acute Care Surg Date: 2012-01 Impact factor: 3.313
Authors: Brian J Eastridge; Charles E Wade; Mary A Spott; George Costanzo; James Dunne; Stephen Flaherty; John B Holcomb; Susan West; Amy Apodaca; Lorne Blackbourne; S Ward Casscells Journal: J Trauma Date: 2010-07
Authors: Mark R Hemmila; Avery B Nathens; Shahid Shafi; J Forrest Calland; David E Clark; H Gill Cryer; Sandra Goble; Christopher J Hoeft; J Wayne Meredith; Melanie L Neal; Michael D Pasquale; Michelle D Pomphrey; John J Fildes Journal: J Trauma Date: 2010-02
Authors: Katherine B Kelly; Megan L Koeppel; John J Como; Jeffrey W Carter; Andrew M McCoy; Jeffrey A Claridge Journal: Am J Surg Date: 2012-01-04 Impact factor: 2.565
Authors: N N Saillant; E Earl-Royal; J L Pascual; S R Allen; P K Kim; M K Delgado; B G Carr; D Wiebe; D N Holena Journal: Eur J Trauma Emerg Surg Date: 2015-10-28 Impact factor: 3.693
Authors: Kristin Salottolo; Patrick J Offner; Alessandro Orlando; Denetta S Slone; Charles W Mains; Matthew Carrick; David Bar-Or Journal: Scand J Trauma Resusc Emerg Med Date: 2015-02-03 Impact factor: 2.953