Racial and Ethnic Differences in the Prevalence of Do-Not-Resuscitate Orders among Older Adults with Severe Traumatic Brain Injury

被引：7

作者：

Hatfield, Jordan ^{[1
]}

Fah, Megan ^{[2
,3
]}

Girden, Alex ^{[2
,3
]}

Mills, Brianna ^{[4
,5
]}

Ohnuma, Tetsu ^{[2
,3
]}

Haines, Krista ^{[6
]}

Cobert, Julien ^{[7
]}

Komisarow, Jordan ^{[8
]}

Williamson, Theresa ^{[9
]}

Bartz, Raquel ^{[7
]}

Vavilala, Monica ^{[5
,10
]}

Raghunathan, Karthik ^{[2
,3
]}

Tobalske, Anwen ^{[11
]}

Ward, Joshua ^{[12
]}

Krishnamoorthy, Vijay ^{[1
,2
,3
]}

机构：

[1] Duke Univ, Sch Med, Durham, NC USA

[2] Duke Univ, Dept Anesthesiol, Durham, NC USA

[3] Duke Univ, Dept Anesthesiol, Crit Care & Perioperat Populat Hlth Res CAPER Uni, Durham, NC USA

[4] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA

[5] Univ Washington, Harborview Injury Prevent & Res Ctr, Seattle, WA 98195 USA

[6] Duke Univ, Surg, Durham, NC USA

[7] Univ Calif San Francisco, Dept Anesthesiol, San Francisco, CA USA

[8] Duke Univ, Neurosurg, Durham, NC USA

[9] Harvard Med Sch, Massachusetts Gen Hosp, Boston, MA 02115 USA

[10] Univ Washington, Dept Anesthesiol, Seattle, WA 98195 USA

[11] Claremont Mckenna Coll, Claremont, CA 91711 USA

[12] Washington Univ, Sch Med, St Louis, MI USA

来源：

JOURNAL OF INTENSIVE CARE MEDICINE | 2022年

关键词：

do not resuscitate; DNR order; ethnicity; traumatic brain injury; ADVANCE DIRECTIVES; OF-LIFE; CARE; EPIDEMIOLOGY; OUTCOMES; QUALITY;

D O I：

10.1177/08850666221103780

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background Older adults suffering from traumatic brain injury (TBI) are subject to higher injury burden and mortality. Do Not Resuscitate (DNR) orders are used to provide care aligned with patient wishes, but they may not be equitably distributed across racial/ethnic groups. We examined racial/ethnic differences in the prevalence of DNR orders at hospital admission in older patients with severe TBI. Methods We conducted a retrospective cohort study using the National Trauma Databank (NTDB) between 2007 to 2016. We examined patients >= 65 years with severe TBI. For our primary aim, the exposure was race/ethnicity and outcome was the presence of a documented DNR at hospital admission. We conducted an exploratory analysis of hospital outcomes including hospital mortality, discharge to hospice, and healthcare utilization (intracranial pressure monitor placement, hospital LOS, and duration of mechanical ventilation). Results Compared to White patients, Black patients (OR 0.48, 95% CI 0.35-0.64), Hispanic patients (OR 0.54, 95% CI 0.40-0.70), and Asian patients (OR 0.63, 95% CI 0.44-0.90) had decreased odds of having a DNR order at hospital admission. Patients with DNRs had increased odds of hospital mortality (OR 2.16, 95% CI 1.94-2.42), discharge to hospice (OR 2.08, 95% CI 1.75-2.46), shorter hospital LOS (-2.07 days, 95% CI -3.07 to -1.08) and duration of mechanical ventilation (-1.09 days, 95% CI -1.52 to -0.67). There was no significant difference in the utilization of ICP monitoring (OR 0.94, 95% CI 0.78-1.12). Conclusions We found significant racial and ethnic differences in the utilization of DNR orders among older patients with severe TBI. Additionally. DNR orders at hospital admission were associated with increased in-hospital mortality, increased hospice utilization, and decreased healthcare utilization. Future studies should examine mechanisms underlying race-based differences in DNR utilization.

引用

页码：1641 / 1647

页数：7

共 23 条

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