Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit

An Yi Wang, Hon Ping Ma, Wei Fong Kao, Shin Han Tsai, Cheng Kuei Chang

Research output: Contribution to journalArticle

Abstract

Background: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. Objective: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. Method: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital. Non-traumatic patients with DNR admitted to ED-ICU from ED were included. Results: Seventy-eight non-trauma patients with prior DNR status were included in the final analysis. 51.3% (40/78) patients were male with median age 83 (IQR: 75–89) years. The median APACHE II score was 24.5 (IQR: 20–30). 50% (39/78) of the DNR patients survived to discharge. Patients who survived to discharge had lower APACHE II score (23 (IQR: 20–28) vs. 28 (18–38), p = 0.028). There was no significant difference in age, gender, and Charlson index. ROC curves were constructed, generating a cut-off of the APACHE II score at 29.5 for determining survival to discharge (AUC = 0.644, p = 0.028). In multivariate Cox proportional model, APACHE II score above 29.5 was an independent predictor for mortality. (Hazard ratio = 2.46; 95% confidence interval: 1.04–5.83, p = 0.042). Conclusions: Our study found that 50% of patients with prior DNR on ICU admission survived to discharge, indicating that aggressive care is not definitely futile. Further prospective studies are required to evaluate the cost-effectiveness and patients’ and/or families’ satisfaction of the ICU admission of DNR patients.

LanguageEnglish
JournalJournal of the Formosan Medical Association
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Intensive Care Units
Hospital Emergency Service
APACHE
Critical Illness
Survival
Critical Care
Proportional Hazards Models
ROC Curve
Area Under Curve
Cost-Benefit Analysis
Cohort Studies
Retrospective Studies
Prospective Studies
Confidence Intervals
Mortality

Keywords

  • Do not resuscitate
  • Futility
  • Intensive care units

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit. / Wang, An Yi; Ma, Hon Ping; Kao, Wei Fong; Tsai, Shin Han; Chang, Cheng Kuei.

In: Journal of the Formosan Medical Association, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. Objective: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. Method: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital. Non-traumatic patients with DNR admitted to ED-ICU from ED were included. Results: Seventy-eight non-trauma patients with prior DNR status were included in the final analysis. 51.3{\%} (40/78) patients were male with median age 83 (IQR: 75–89) years. The median APACHE II score was 24.5 (IQR: 20–30). 50{\%} (39/78) of the DNR patients survived to discharge. Patients who survived to discharge had lower APACHE II score (23 (IQR: 20–28) vs. 28 (18–38), p = 0.028). There was no significant difference in age, gender, and Charlson index. ROC curves were constructed, generating a cut-off of the APACHE II score at 29.5 for determining survival to discharge (AUC = 0.644, p = 0.028). In multivariate Cox proportional model, APACHE II score above 29.5 was an independent predictor for mortality. (Hazard ratio = 2.46; 95{\%} confidence interval: 1.04–5.83, p = 0.042). Conclusions: Our study found that 50{\%} of patients with prior DNR on ICU admission survived to discharge, indicating that aggressive care is not definitely futile. Further prospective studies are required to evaluate the cost-effectiveness and patients’ and/or families’ satisfaction of the ICU admission of DNR patients.",
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AB - Background: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. Objective: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. Method: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital. Non-traumatic patients with DNR admitted to ED-ICU from ED were included. Results: Seventy-eight non-trauma patients with prior DNR status were included in the final analysis. 51.3% (40/78) patients were male with median age 83 (IQR: 75–89) years. The median APACHE II score was 24.5 (IQR: 20–30). 50% (39/78) of the DNR patients survived to discharge. Patients who survived to discharge had lower APACHE II score (23 (IQR: 20–28) vs. 28 (18–38), p = 0.028). There was no significant difference in age, gender, and Charlson index. ROC curves were constructed, generating a cut-off of the APACHE II score at 29.5 for determining survival to discharge (AUC = 0.644, p = 0.028). In multivariate Cox proportional model, APACHE II score above 29.5 was an independent predictor for mortality. (Hazard ratio = 2.46; 95% confidence interval: 1.04–5.83, p = 0.042). Conclusions: Our study found that 50% of patients with prior DNR on ICU admission survived to discharge, indicating that aggressive care is not definitely futile. Further prospective studies are required to evaluate the cost-effectiveness and patients’ and/or families’ satisfaction of the ICU admission of DNR patients.

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