Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage

被引:30
作者
Zahuranec, Darin B. [1 ]
Brown, Devin L. [1 ]
Lisabeth, Lynda D. [1 ,2 ]
Gonzales, Nicole R. [3 ]
Longwell, Paxton J.
Smith, Melinda A. [1 ]
Garcia, Nelda M. [1 ]
Morgenstern, Lewis B. [1 ,2 ]
机构
[1] Univ Michigan, Sch Med, Stroke Program, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Sch Publ Hlth, Dept Epidemiol, Ann Arbor, MI 48109 USA
[3] Univ Texas Med Sch Houston, Stroke Program, Houston, TX USA
关键词
cerebral hemorrhage; Mexican-Americans; resuscitation orders; NON-HISPANIC WHITES; MEXICAN-AMERICANS; MORTALITY; STROKE; PREFERENCES; ADJUSTMENT; ATTITUDES;
D O I
10.1097/CCM.0b013e3181a56755
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. Design: Population-based surveillance. Setting: Corpus Christi, Texas. Patients: All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. Interventions: None. Measurements and Main Results: Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ("any do-not-resuscitate") and within 24 hrs of presentation ("early do-not-resuscitate"), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, modified Charlson Index, and admission from a nursing home. A total of 270 cases of intracerebral hemorrhage from 2000-2003 were analyzed. Mexican-Americans were younger and had a higher Glasgow Coma Scale than non-Hispanic whites. Mexican-Americans were half as likely as non-Hispanic whites to have early do-not-resuscitate orders in unadjusted analysis (odds ratio 0.45, 95% confidence interval 0.27, 0.75), although this association was not significant when adjusted for age (odds ratio 0.61, 95% confidence interval 0.35, 1.06) and in the fully adjusted model (odds ratio 0.75, 95% confidence interval 0.39, 1.46). Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders written at any time point (odds ratio 0.37, 95% confidence interval 0.23, 0.61). Adjustment for age alone attenuated this relationship although it retained significance (odds ratio 0.49, 95% confidence interval 0.29, 0.82). In the fully adjusted model, Mexican-Americans were less likely than non-Hispanic whites to use do-not-resuscitate orders at any time point, although the 95% confidence interval included one (odds ratio 0.52, 95% confidence interval 0.27, 1.00). Conclusions: Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders after intracerebral hemorrhage although the association was attenuated after adjustment for age and other confounders. The persistent trend toward less frequent use of do-not-resuscitate orders in Mexican-Americans suggests that further study is warranted. (Crit Care Med 2009; 37:2807-2811)
引用
收藏
页码:2807 / 2811
页数:5
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