Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit

Abstract

Admission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p < 0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead; p = 0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility. Conclusions. Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status.

The Impact of Signing Do-Not-Resuscitate Orders on the Use of Non-Beneficial Life-Sustaining Treatments for Intensive Care Unit Patients: A Retrospective Study

“…The study showed that not all patients (82.6%) signed the DNR order before death. The percentage of DNR signing was higher than that in previous studies ([ 11 , 20 , 21 ], which reported that less than 40% of patients had signed DNR orders before death. However, the signed DNR ratio was higher than the study result in 2010 under two similar ICU medical systems [ 11 ].…”

Factors associated with treatment limitations in two Swedish intensive care units: Prevalence and patient involvement

“…The lower ICU mortality (20% vs. 26.2%) that we observed among patients in the TL before ICU group was accompanied by slightly lower mean age, lower SAPS3 score, and shorter LOS. Saha et al 10 explored the outcome of patients with prior DNAR status that were admitted to the ICU and observed a high in‐hospital mortality (45.7%). Among the remaining 19 patients in their single center study 50% were discharged home, 30% to hospice, and 20% to postacute care facilities.…”

Use of intensive care unit priority model in directing intensive care unit admission in Sudan: A prospective cross-sectional study

“…reported that the mortality rate for all patients who were DNR was 33.4% in compare to about 5% mortality rate for all patients who were not DNR ( P < 0.001). [ 29 ] This should be seen as an associated factor, since DNR is usually issued for those with increased mortality. In Sudan, the guidelines and application of DNR or end of life care are not clear yet and there is no documented local statistics.…”