Julia Chia-Yu Chang1,2, Che Yang3, Li-Ling Lai3, Ying-Ju Chen1,2, Hsien-Hao Huang1,2,4, Ju-Sing Fan1,2, Teh-Fu Hsu1,2, David Hung-Tsang Yen1,2,4,5. 1. Department of Emergency Department, Taipei Veterans General Hospital, Taipei 11217, Taiwan. 2. School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan. 3. Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan. 4. Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei 11221, Taiwan. 5. Department of Emergency Medicine, National Defense Medical Center, Taipei 11217, Taiwan.
Abstract
Background: A do-not-resuscitate (DNR) order is associated with an increased risk of death among emergency department (ED) patients. Little is known about patient characteristics, hospital care, and outcomes associated with the timing of the DNR order. Aim: Determine patient characteristics, hospital care, survival, and resource utilization between patients with early DNR (EDNR: signed within 24 h of ED presentation) and late DNR orders. Design: Retrospective observational study. Setting/Participants: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit (EICU) at Taipei Veterans General Hospital from 1 February 2018, to 31 January 2020. Results: Of the 1064 patients admitted to the EICU, 619 (58.2%) had EDNR and 445 (41.8%) LDNR. EDNR predictors were age >85 years (adjusted odd ratios (AOR) 1.700, 1.027-2.814), living in long-term care facilities (AOR 1.880, 1.066-3.319), having advanced cardiovascular diseases (AOR 2.128, 1.039-4.358), "medical staff would not be surprised if the patient died within 12 months" (AOR 1.725, 1.193-2.496), and patients' family requesting palliative care (AOR 2.420, 1.187-4.935). EDNR patients underwent lesser endotracheal tube (ET) intubation (15.6% vs. 39.9%, p < 0.001) and had reduced epinephrine injection (19.9% vs. 30.3%, p = 0.009), ventilator support (16.7% vs. 37.9%, p < 0.001), and narcotic use (51.1% vs. 62.6%, p = 0.012). EDNR patients had significantly lower 7-day (p < 0.001), 30-day (p < 0.001), and 90-day (p = 0.023) survival. Conclusions: EDNR patients underwent decreased ET intubation and had reduced epinephrine injection, ventilator support, and narcotic use during EOL as well as decreased length of hospital stay, hospital expenditure, and survival compared to LDNR patients.
Background: A do-not-resuscitate (DNR) order is associated with an increased risk of death among emergency department (ED) patients. Little is known about patient characteristics, hospital care, and outcomes associated with the timing of the DNR order. Aim: Determine patient characteristics, hospital care, survival, and resource utilization between patients with early DNR (EDNR: signed within 24 h of ED presentation) and late DNR orders. Design: Retrospective observational study. Setting/Participants: We enrolled consecutive, acute, critically illpatients admitted to the emergency intensive care unit (EICU) at Taipei Veterans General Hospital from 1 February 2018, to 31 January 2020. Results: Of the 1064 patients admitted to the EICU, 619 (58.2%) had EDNR and 445 (41.8%) LDNR. EDNR predictors were age >85 years (adjusted odd ratios (AOR) 1.700, 1.027-2.814), living in long-term care facilities (AOR 1.880, 1.066-3.319), having advanced cardiovascular diseases (AOR 2.128, 1.039-4.358), "medical staff would not be surprised if the patientdied within 12 months" (AOR 1.725, 1.193-2.496), and patients' family requesting palliative care (AOR 2.420, 1.187-4.935). EDNR patients underwent lesser endotracheal tube (ET) intubation (15.6% vs. 39.9%, p < 0.001) and had reduced epinephrine injection (19.9% vs. 30.3%, p = 0.009), ventilator support (16.7% vs. 37.9%, p < 0.001), and narcotic use (51.1% vs. 62.6%, p = 0.012). EDNR patients had significantly lower 7-day (p < 0.001), 30-day (p < 0.001), and 90-day (p = 0.023) survival. Conclusions: EDNR patients underwent decreased ET intubation and had reduced epinephrine injection, ventilator support, and narcotic use during EOL as well as decreased length of hospital stay, hospital expenditure, and survival compared to LDNR patients.
Entities:
Keywords:
do-not-resuscitate; emergency department; hospital care; intensive care unit
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