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Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study

Brizzi, Marco LU ; Abul-Kasim, Kasim LU ; Jalakas, Mattis; Selariu, Eufrozina LU ; Pessah-Rasmussen, Hélène LU and Zia, Elisabet LU (2012) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 20.
Abstract
Introduction: In former studies from North America early Do-Not-Resuscitate orders (DNR orders) in patients with intracerebral haemorrhage (ICH) had negative prognostic impact on mortality. The influence of DNR orders on functional outcome and whether DNR orders are grounded on relevant patient characteristics is unknown. We aimed to determine the frequency and predictive factors of DNR-orders and its association to prognosis, in ICH patients, in Scandinavia. Methods: In 197 consecutive ICH patients admitted to Skane University Hospital, Malmo, Sweden, between January 2007 and June 2009, information of the presence of DNR orders within 48 hours, clinical and radiological characteristics was retrieved by review of patient medical journal... (More)
Introduction: In former studies from North America early Do-Not-Resuscitate orders (DNR orders) in patients with intracerebral haemorrhage (ICH) had negative prognostic impact on mortality. The influence of DNR orders on functional outcome and whether DNR orders are grounded on relevant patient characteristics is unknown. We aimed to determine the frequency and predictive factors of DNR-orders and its association to prognosis, in ICH patients, in Scandinavia. Methods: In 197 consecutive ICH patients admitted to Skane University Hospital, Malmo, Sweden, between January 2007 and June 2009, information of the presence of DNR orders within 48 hours, clinical and radiological characteristics was retrieved by review of patient medical journal and computed tomography scans. Determinants of DNR-orders, one-month case fatality and bad functional outcome (modified Rankin Scale, grade 4-6) were assessed by logistic regression analysis. Results: DNR orders were made in 41% of the cases. After adjustment for confounding factors, age >= 75 years (Odds Ratio (95% confidence interval) 4.2(1.8-9.6)), former stroke (5.1(1.9-3.1)), Reaction Level Scale grade 2-3 and 4 (7.0(2.8-17.5) and (4.1(1.2-13.5), respectively) and intraventricular haemorrhage (3.8(1.6-9.4)) were independent determinants of early DNR orders. Independent predictors of one-month case fatality was age >= 75 years (3.7(1.4-9.6)) volume >= 30 ml (3.5(1.3-9.6)) and DNR orders (3.5(1.5-8.6)). Seizure (6.0(1.04-34.2) and brain stem hemorrhage (8.0(1.1-58.4)) were related to bad functional outcome, whereas early DNR order was not (3.5(0.99-12.7)). Conclusions: Well known prognostic factors are determinants for DNR orders, however DNR orders are independently related to one-month case fatality. In addition to improvements of the local routines, we welcome a change of attitude with an enhanced awareness of the definition of, and a more careful approach with respect to DNR orders. (Less)
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Contribution to journal
publication status
published
subject
keywords
Intracerebral haemorrhage, Prognosis, Functional outcome, Mortality, Do, not resuscitate orders
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
20
publisher
BioMed Central
external identifiers
  • wos:000310747100001
  • scopus:84861399251
ISSN
1757-7241
DOI
10.1186/1757-7241-20-36
language
English
LU publication?
yes
id
973af328-4c92-4261-b2c0-3dbc18b8fbaa (old id 3283233)
date added to LUP
2013-01-07 09:39:58
date last changed
2017-08-20 04:01:03
@article{973af328-4c92-4261-b2c0-3dbc18b8fbaa,
  abstract     = {Introduction: In former studies from North America early Do-Not-Resuscitate orders (DNR orders) in patients with intracerebral haemorrhage (ICH) had negative prognostic impact on mortality. The influence of DNR orders on functional outcome and whether DNR orders are grounded on relevant patient characteristics is unknown. We aimed to determine the frequency and predictive factors of DNR-orders and its association to prognosis, in ICH patients, in Scandinavia. Methods: In 197 consecutive ICH patients admitted to Skane University Hospital, Malmo, Sweden, between January 2007 and June 2009, information of the presence of DNR orders within 48 hours, clinical and radiological characteristics was retrieved by review of patient medical journal and computed tomography scans. Determinants of DNR-orders, one-month case fatality and bad functional outcome (modified Rankin Scale, grade 4-6) were assessed by logistic regression analysis. Results: DNR orders were made in 41% of the cases. After adjustment for confounding factors, age >= 75 years (Odds Ratio (95% confidence interval) 4.2(1.8-9.6)), former stroke (5.1(1.9-3.1)), Reaction Level Scale grade 2-3 and 4 (7.0(2.8-17.5) and (4.1(1.2-13.5), respectively) and intraventricular haemorrhage (3.8(1.6-9.4)) were independent determinants of early DNR orders. Independent predictors of one-month case fatality was age >= 75 years (3.7(1.4-9.6)) volume >= 30 ml (3.5(1.3-9.6)) and DNR orders (3.5(1.5-8.6)). Seizure (6.0(1.04-34.2) and brain stem hemorrhage (8.0(1.1-58.4)) were related to bad functional outcome, whereas early DNR order was not (3.5(0.99-12.7)). Conclusions: Well known prognostic factors are determinants for DNR orders, however DNR orders are independently related to one-month case fatality. In addition to improvements of the local routines, we welcome a change of attitude with an enhanced awareness of the definition of, and a more careful approach with respect to DNR orders.},
  author       = {Brizzi, Marco and Abul-Kasim, Kasim and Jalakas, Mattis and Selariu, Eufrozina and Pessah-Rasmussen, Hélène and Zia, Elisabet},
  issn         = {1757-7241},
  keyword      = {Intracerebral haemorrhage,Prognosis,Functional outcome,Mortality,Do,not resuscitate orders},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine},
  title        = {Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study},
  url          = {http://dx.doi.org/10.1186/1757-7241-20-36},
  volume       = {20},
  year         = {2012},
}