Preadmission Do Not Resuscitate advanced directive is associated with adverse outcomes following acute traumatic injury

Jawa, Randeep S.; Shapiro, Marc J.; McCormack, Jane E.; Huang, Emily; Rutigliano, Daniel N.; Vosswinkel, James A.

doi:10.1016/j.amjsurg.2015.04.007

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…Between 2012 and 2013, only the RTC and three of four ATCs participated. This registry has been previously used for research …”

Section: Methodsmentioning

confidence: 99%

“…This registry has been previously used for research. 13,14 Older adult trauma patients, aged ≥65 years, falling from low levels, (i.e., patients with ICD-9 [CM] E-codes 880, 881, 883, 884, 885, 886, 887, 888, 889 indicating a fall with subcategories indicating fall height as under 3 feet) who were admitted to the hospital, regardless of admitting service or trauma team involvement, between January 2004 and December 2013 were included. Deaths in the emergency department and burns were excluded.…”

Section: Methodsmentioning

confidence: 99%

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Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Jawa

Singer

Rutigliano

et al. 2016

J American Geriatrics Society

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“…Between 2012 and 2013, only the RTC and three of four ATCs participated. This registry has been previously used for research …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Spinal Fractures in Older Adult Patients Admitted After Low‐Level Falls: 10‐Year Incidence and Outcomes

Jawa

Singer

Rutigliano

et al. 2016

J American Geriatrics Society

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“…For example, we may recognize metastatic cancer as an intractable terminable disease while believing there are always more interventions to salvage patients with cardiac and surgical problems. At the same time, evidence suggests that in some (surgical) settings, prematurely labeling patients “DNR” may result in worse outcomes perhaps from unintended “failure to rescue.”[ 34 , 35 ] This study alone cannot judge whether any of the observed practices are “appropriate” or not, but does illustrate that differences exist.…”

Section: Discussionmentioning

confidence: 85%

Reversals and limitations on high-intensity, life-sustaining treatments

et al. 2018

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ImportanceCritically ill patients often receive high-intensity life sustaining treatments (LST) in the intensive care unit (ICU), although they can be ineffective and eventually undesired. Determining the risk factors associated with reversals in LST goals can improve patient and provider appreciation for the natural history and epidemiology of critical care and inform decision making around the (continued) use of LSTs.MethodsThis is a single institution retrospective cohort study of patients receiving life sustaining treatment in an academic tertiary hospital from 2009 to 2013. Deidentified patient electronic medical record data was collected via the clinical data warehouse to study the outcomes of treatment limiting Comfort Care and do-not-resuscitate (DNR) orders. Extended multivariable Cox regression models were used to estimate the association of patient and clinical factors with subsequent treatment limiting orders.Results10,157 patients received life-sustaining treatment while initially Full Code (allowing all resuscitative measures). Of these, 770 (8.0%) transitioned to Comfort Care (with discontinuation of any life-sustaining treatments) while 1,669 (16%) patients received new DNR orders that reflect preferences to limit further life-sustaining treatment options. Patients who were older (Hazard Ratio(HR) 1.37 [95% CI 1.28–1.47] per decade), with cerebrovascular disease (HR 2.18 [95% CI 1.69–2.81]), treated by the Medical ICU (HR 1.92 [95% CI 1.49–2.49]) and Hematology-Oncology (HR 1.87 [95% CI 1.27–2.74]) services, receiving vasoactive infusions (HR 1.76 [95% CI 1.28, 2.43]) or continuous renal replacement (HR 1.83 [95% CI 1.34, 2.48]) were more likely to transition to Comfort Care. Any new DNR orders were more likely for patients who were older (HR 1.43 [95% CI 1.38–1.48] per decade), female (HR 1.30 [95% CI 1.17–1.44]), with cerebrovascular disease (HR 1.45 [95% CI 1.25–1.67]) or metastatic solid cancers (HR 1.92 [95% CI 1.48–2.49]), or treated by Medical ICU (HR 1.63 [95% CI 1.42–1.86]), Hematology-Oncology (HR 1.63 [95% CI 1.33–1.98]) and Cardiac Care Unit-Heart Failure (HR 1.41 [95% CI 1.15–1.72]).ConclusionDecisions to reverse or limit treatment goals occurs after more than 1 in 13 trials of LST, and is associated with older female patients, receiving non-ventilator forms of LST, cerebrovascular disease, and treatment by certain medical specialty services.

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“…Other studies have also demonstrated a significant mortality rate associated with DNR orders ranging from 22% to 99% [2][3][4]13]. This high mortality for patients with an inpatient institution of a DNR order may be related to the poor prognosis as recognized by clinicians, prompting the initiation of a DNR order.…”

Section: Discussionmentioning

confidence: 89%