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Abstract Details

Do Not Resuscitate Orders In Subarachnoid Hemorrhage Patients. Impact On Mortality
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
094
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.
NA
We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all subarachnoid 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 325923
patients with SAH, 20127 (6.17%%) had DNR order. SAH patients with DNR order had higher proportion of
females (61.7% versus 59.4%, P=0.0048) and were older (70.9 years versus 58.4 years, P <.0001) compared to SAH
patients without DNR. The in-hospital mortality was also higher (66.4% versus 22.4%, p≤.0001) among patients
with DNR both univariate and multivariate analysis (OR = 5.05 (4.58 -5.56), p<.0001) after adjusting for potential
confounders. Whites have a higher rate (7.59% versus 5.84%, P <.0001) 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
Mohammad Rauf A. Chaudhry, MD
PRESENTER 		Dr. Chaudhry has nothing to disclose.
Mohammad Ghatali, MD (Texas Tech Health Science Center) Dr. Ghatali has nothing to disclose.
Harathi Bandaru, MD Dr. Bandaru has nothing to disclose.
Edwin Lopez, NP (Texas Tech Neurology) No disclosure on file
Baljinder Singh, MD Dr. Singh 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.