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Titolo:
VARIATION IN THE USE OF DO-NOT-RESUSCITATE ORDERS IN PATIENTS WITH STROKE
Autore:
SHEPARDSON LB; YOUNGNER SJ; SPEROFF T; OBRIEN RG; SMYTH KA; ROSENTHAL GE;
Indirizzi:
CASE WESTERN RESERVE UNIV,SCH MED,CTR BIOMED ETH,ROOM WG-37,10900 EUCLID AVE CLEVELAND OH 44106 CASE WESTERN RESERVE UNIV,SCH MED,CTR BIOMED ETH CLEVELAND OH 44106 VET AFFAIRS MED CTR,DEPT EPIDEMIOL & BIOSTAT CLEVELAND OH 00000 VET AFFAIRS MED CTR,DIV GEN INTERNAL MED & HLTH CARE RES CLEVELAND OH00000 UNIV HOSP CLEVELAND,CLIN ETH PROGRAM CLEVELAND OH 44106 CLEVELAND CLIN FDN,DEPT BIOSTAT CLEVELAND OH 44195
Titolo Testata:
Archives of internal medicine
fascicolo: 16, volume: 157, anno: 1997,
pagine: 1841 - 1847
SICI:
0003-9926(1997)157:16<1841:VITUOD>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTENSIVE-CARE UNITS; ILL PATIENTS; OUTCOMES; AGE; DECISIONS; PREFERENCES; QUALITY; ILLNESS; IMPACT; CHOICE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
28
Recensione:
Indirizzi per estratti:
Citazione:
L.B. Shepardson et al., "VARIATION IN THE USE OF DO-NOT-RESUSCITATE ORDERS IN PATIENTS WITH STROKE", Archives of internal medicine, 157(16), 1997, pp. 1841-1847

Abstract

Objectives: To identify sociodemographic and clinical characteristicsassociated with the use of do-not-resuscitate (DNR) orders in hospitalized patients with stroke. To examine whether the use of DNR orders varies across hospitals. Methods: This observational cohort study used data collected for 13 337 consecutive eligible patients with a primarydiagnosis of stroke. These patients were discharged in 1991 through 1994 from 30 hospitals in a large metropolitan area. Study data were abstracted from patients' hospital records using standard forms. Admission severity of illness was measured using a validated multivariable model. Sociodemographic and clinical factors independently associated with the use of DNR orders were identified using stepwise logistic regression. Results: Do-not-resuscitate orders were written for 2898 patients (22%). Patient characteristics independently (P<.01) associated with increased use of DNR orders included increasing age (odds ratio [OR], 1.06 per year); admission from a skilled nursing facility (OR, 2.44)or through the emergency department (OR, 1.49); cancer (OR, 2.73), intracerebral hemorrhage (OR, 2.12), coma (OR, 7.47), or lethargy or stupor on admission neurological assessment (OR, 3.38); and increasing admission severity (OR, 1.29 per decile). In contrast, African American race was associated with lower use of DNR orders (OR, 0.54). Although substantial variation in the use of DNR orders was observed across hospitals, with rates ranging from 12% to 32%, adjusting for the above patient characteristics eliminated much of this variation, including differences between major teaching and other hospitals and between hospitals with and without religious affiliations. Conclusions: In our community-based analysis of patients with stroke, the use of DNR orders wascommon and was strongly related to several patient characteristics. These factors explained much of the variation across hospitals. While our analysis did not account for differences in patient preferences fortreatment, the differences we observed in the use of DNR orders across sociodemographic groups are suggestive of variations in care and mayhave important implications for the cost and quality of hospital care.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/08/20 alle ore 17:01:15