Is early DNR a self-fulfilling prophecy for patients with spontaneous intracerebral hemorrhage?

A. Jain, M. Jain, M. F. Bellolio, R. M. Schears, A. A. Rabinstein, L. Ganti

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: To investigate differences in outcome of patients with intracerebral hemorrhage (ICH) based on institution of do-not-resuscitate (DNR) order within first 24 h of admission. Methods: A prospective registry of patients presenting with ICH from Jan 2006 to Dec 2008 was created. Patients with and without DNR orders instituted within 24 h of admission were classified as cases and controls respectively and were matched based on age and stroke severity. Demographics, intracerebral volume of hematoma, intraventricular extension of hemorrhage (IVH), invasive treatments, and outcomes at discharge were collected. All patients were followed up at least for 1 year, to determine mortality outcomes. Results: Of a total of 245 subjects, 18 % had DNR order instituted within 24 h of admission. After matching, a total of 69 controls were available for 44 cases. There was no difference in demographics, IVH extension, volume of hemorrhage, and length of stay among cases and controls. Higher proportions of controls had surgical evacuation of the hematoma (p = 0.0125) and mechanical ventilation (p = 0.0001). There was no significant difference in functional outcome and survival rates among cases and controls at the end of 1 week, 1 month, and 1 year. Conclusions: DNR institution and restriction of resuscitation was not associated with poor outcome or difference in survival within 1 year after ICH. This indicates an early DNR probably does not lead to a self-fulfilling prophecy in this population, and might be explained by our practice, were DNR orders do not impact the level of supportive medical care we provide.

Original languageEnglish (US)
Pages (from-to)342-346
Number of pages5
JournalNeurocritical care
Volume19
Issue number3
DOIs
StatePublished - Dec 1 2013

Keywords

  • Cerebral hemorrhage
  • Do-not-resuscitate orders
  • Outcomes research

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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