Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU*
- 1 June 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 45 (6), 1019-1027
- https://doi.org/10.1097/ccm.0000000000002312
Abstract
Objectives: We quantified the 28-day mortality effect of preexisting do-not-resuscitate orders in ICUs. Design: Longitudinal, retrospective study of patients admitted to five ICUs at a tertiary university medical center (Beth Israel Deaconess Medical Center, BIDMC, Boston, MA) between 2001 and 2008. Intervention: None. Patients: Two cohorts were defined: patients with do not resuscitate advance directives on day 1 of ICU admission and a control group comprising patients with no limitations of level of care on ICU day 1 (full code). Measurements and Main Results: The primary outcome was mortality at 28 days after ICU admission. Of 19,007 ICU patients, 1,239 patients (6.5%) had a do-not-resuscitate order on the first day of ICU admission and survived 48 hours in the ICU. We matched those do-not-resuscitate patients with 2,402 patients with full-code status. Twenty-eight day and 1-year mortality were both significantly higher in the do-not-resuscitate group (33.9% vs 18.4% and 60.7% vs 40.2%; p < 0.001, respectively). Conclusion: Do-not-resuscitate status is an independent risk factor for ICU mortality. This may reflect severity of illness not captured by other clinical factors, but the perceptions of the treating team related to do-not-resuscitate status could also be causally responsible for increased mortality in patients with do-not-resuscitate status.Keywords
This publication has 34 references indexed in Scilit:
- TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate OrdersThe Journal of Emergency Medicine, 2012
- Multiparameter Intelligent Monitoring in Intensive Care II: A public-access intensive care unit database*Critical Care Medicine, 2011
- Pre-existing do-not-resuscitate orders are not associated with increased postoperative morbidity at 30 days in surgical patients*Critical Care Medicine, 2011
- DNR And Advance Directives: International PerspectiveHealth Affairs, 2010
- A Modification of the Elixhauser Comorbidity Measures Into a Point System for Hospital Death Using Administrative DataMedical Care, 2009
- Impact of do-not-resuscitation orders on quality of care performance measures in patients hospitalized with acute heart failureAmerican Heart Journal, 2008
- "Allow natural death" versus "do not resuscitate": three words that can change a lifeJournal of Medical Ethics, 2008
- DNR directives are established early in mechanically ventilated intensive care unit patientsCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 2004
- Scale of levels of care versus DNR ordersJournal of Medical Ethics, 2004
- A simplified acute physiology score for ICU patientsCritical Care Medicine, 1984