Jessica McFarlin1, Claire E Hailey2, Wenjing Qi3, Peter G Kranz4, Weiping Sun5, Wei Sun5, Marisa Gray6, Nicolas Kon Kam King7, Daniel T Laskowitz8, Michael L James9. 1. 1 Department of Neurology, University of Kentucky , Lexington, Kentucky. 2. 2 Department of Pediatrics, University of Chicago , Chicago, Illinois. 3. 3 Department of Biostatistics, Duke University , Durham, North Carolina. 4. 4 Department of Radiology, Duke University , Durham, North Carolina. 5. 5 Department of Neurology, Peking University First Hospital , Beijing, P.R. China . 6. 6 Department of Urology, University of Virginia , Charlottesville, Virginia. 7. 7 Department of Neurosurgery, National Neuroscience Institute , DukeNUS School of Medicine, Singapore, Singapore . 8. 8 Departments of Neurology, Anesthesiology, and Neurobiology, Brain Injury Translational Research Center, Duke University , Durham, North Carolina. 9. 9 Departments of Anesthesiology & Neurology, Brain Injury Translational Research Center, Duke University , Durham, North Carolina.
Abstract
BACKGROUND: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognosis, understanding prognostic indicators that influence clinical judgment of outcomes is critical. OBJECTIVE: The purpose of this study was to understand the patient variables and comorbid illnesses associated with DNR orders placed on patients within 72 hours after ICH. DESIGN: Single-center, retrospective review of medical records of 198 consecutive patients with an admission diagnosis of primary supratentorial ICH between July 2007 and December 2010. SUBJECTS: Patients who did not experience a DNR order placement during their primary admission for ICH (non-DNR group) were compared to patients who received a new DNR order in the first 72 hours of admission (DNR group). MEASUREMENTS: Patient characteristics obtained include demographic data, past medical history, clinical data pertaining to the admission for the ICH, and radiographic images. Demographic, medical, and ICH injury data during the first three days of admission were collected. RESULTS: Multiple differences in patient and hospital factors were found between patients receiving a new, early DNR order and those who did not receive a DNR order after ICH. In regression modeling, Caucasian race, direct admission, and higher ICH score were associated with placement of a new DNR order early in the course of injury. CONCLUSIONS: Race, transfer procedures, and injury severity may be important factors associated with placement of new, early DNR orders in patients after ICH.
BACKGROUND: Decisions to limit care, including use of a do-not-resuscitate (DNR) order, are associated with increased risk of death after intracerebral hemorrhage (ICH). Given the value that patient surrogates place on the physician's perception of prognosis, understanding prognostic indicators that influence clinical judgment of outcomes is critical. OBJECTIVE: The purpose of this study was to understand the patient variables and comorbid illnesses associated with DNR orders placed on patients within 72 hours after ICH. DESIGN: Single-center, retrospective review of medical records of 198 consecutive patients with an admission diagnosis of primary supratentorial ICH between July 2007 and December 2010. SUBJECTS:Patients who did not experience a DNR order placement during their primary admission for ICH (non-DNR group) were compared to patients who received a new DNR order in the first 72 hours of admission (DNR group). MEASUREMENTS: Patient characteristics obtained include demographic data, past medical history, clinical data pertaining to the admission for the ICH, and radiographic images. Demographic, medical, and ICH injury data during the first three days of admission were collected. RESULTS: Multiple differences in patient and hospital factors were found between patients receiving a new, early DNR order and those who did not receive a DNR order after ICH. In regression modeling, Caucasian race, direct admission, and higher ICH score were associated with placement of a new DNR order early in the course of injury. CONCLUSIONS: Race, transfer procedures, and injury severity may be important factors associated with placement of new, early DNR orders in patients after ICH.
Entities:
Keywords:
do-not-resuscitate orders; intracerebal hemorrhage; neurocritical care