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Abstract Details

Do Not Resuscitate Orders In Intracerebral Hemorrhage Patients. Impact On Mortality
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
071
Do not resuscitate (DNR) orders have been associated with higher mortality in
hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites.
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We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage
(ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups.
Of the 884379 patients with ICH, 81968 (9.26%%) had DNR order. ICH patients with DNR order had higher proportion of females (55.1% versus 49.1%, P <.0001) and were older (74.2 years versus 66 years, P <.0001) compared to ICH patients without DNR. The in-hospital mortality was also higher (53.4% versus 23.3%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 3.24 (3.07 -3.41), p<.0001) after adjusting for potential confounders. Whites have a higher rate (11.5% versus 8.08%) of DNR order as compared to other racial/ethnic groups
While there may be other explanations at play, the higher mortality and shorter LOS suggest
that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among
minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.
Authors/Disclosures
Harathi Bandaru, MD
PRESENTER 		Dr. Bandaru has nothing to disclose.
Hussan Gill Mr. Gill has nothing to disclose.
Mohammad Rauf A. Chaudhry, MD Dr. Chaudhry has nothing to disclose.
Baljinder Singh, MD Dr. Singh has nothing to disclose.
Mohammad Ghatali, MD (Texas Tech Health Science Center) Dr. Ghatali has nothing to disclose.
Sushma R. Yerram, MD (Texas tech University of Health Sciences) Dr. Yerram has nothing to disclose.
Anantha Vellipuram, MD Dr. Vellipuram has nothing to disclose.
Alberto Maud, MD (Paul L. Foster School of Medicine Texas Tech UHSC El Paso, Texas) Dr. Maud has nothing to disclose.
Paisith Piriyawat, MD (Texas Tech University) Dr. Piriyawat has nothing to disclose.
Gustavo J. Rodriguez, MD (Gustavo J. Rodriguez) Dr. Rodriguez has nothing to disclose.
Salvador Cruz-Flores, MD, FÂ鶹´«Ã½Ó³»­ (Paul L. Foster School of Medicine Texas Tech University Health Sciences Center) The institution of Dr. Cruz-Flores has received research support from University of Texas System.