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

研究成果: 雜誌貢獻文章

摘要

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.
原文英語
期刊Journal of the Formosan Medical Association
DOIs
出版狀態已發佈 - 一月 2019

指紋

Emergency Medical Services
APACHE
Intensive Care Units
Hospital Emergency Service
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

ASJC Scopus subject areas

  • Medicine(all)

引用此文

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title = "Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit",
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.",
keywords = "Do not resuscitate, Futility, Intensive care units",
author = "Wang, {An Yi} and Ma, {Hon Ping} and Kao, {Wei Fong} and Tsai, {Shin Han} and Chang, {Cheng Kuei}",
year = "2019",
month = "1",
doi = "10.1016/j.jfma.2018.03.016",
language = "English",
journal = "Journal of the Formosan Medical Association",
issn = "0929-6646",
publisher = "Elsevier Science Publishers B.V.",

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TY - JOUR

T1 - Characteristics and outcomes of “Do Not Resuscitate” patients admitted to the emergency department–Intensive care unit

AU - Wang, An Yi

AU - Ma, Hon Ping

AU - Kao, Wei Fong

AU - Tsai, Shin Han

AU - Chang, Cheng Kuei

PY - 2019/1

Y1 - 2019/1

N2 - 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.

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.

KW - Do not resuscitate

KW - Futility

KW - Intensive care units

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