Your browser doesn't support javascript.
loading
Racial disparities in end-of-life suffering within surgical intensive care units.
Haddad, Diane N; Meredyth, Nicole; Hatchimonji, Justin; Merulla, Elizabeth; Matta, Amy; Saucier, Jason; Sharoky, Catherine E; Bass, Gary Alan; Pascual, Jose L; Martin, Niels D.
Afiliación
  • Haddad DN; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Meredyth N; Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA.
  • Hatchimonji J; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Merulla E; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Matta A; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Saucier J; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Sharoky CE; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Bass GA; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Pascual JL; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Martin ND; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Trauma Surg Acute Care Open ; 9(1): e001367, 2024.
Article en En | MEDLINE | ID: mdl-39296594
ABSTRACT

Background:

End-of-life (EOL) care is associated with high resource utilization. Recognizing and effectively communicating that EOL is near promotes more patient-centered care, while decreasing futile interventions. We hypothesize that provider assessment of futility during the surgical intensive care unit (SICU) admission would result in higher rates of Do Not Resuscitate (DNR).

Methods:

We performed a retrospective review of a prospective SICU registry of all deceased patients across a health system, 2018-2022. The registry included a subjective provider assessment of patient's expected survival. We employed multivariable logistic regression to adjust for clinical factors while assessing for association between code status at death and provider's survival assessment with attention to race-based differences.

Results:

746 patients-105 (14.1%) traumatically injured and 641 (85.9%) non-traumatically injured-died over 4.5 years in the SICU (mortality rate 5.9%). 26.3% of these deaths were expected by the ICU provider. 40.9% of trauma patients were full code at the time of death, compared with 15.6% of non-traumatically injured patients. Expected death was associated with increased odds of DNR code status for non-traumatically injured patients (OR 1.8, 95% CI 1.03 to 3.18), but not for traumatically injured patients (OR 0.82, 95% CI 0.22 to 3.08). After adjusting for demographic and clinical characteristics, black patients were less likely to be DNR at the time of death (OR 0.49, 95% CI 0.32 to 0.75).

Conclusion:

20% of patients who died in our SICU had not declared a DNR status, with injured black patients more likely to remain full code at the time of death. Further evaluation of this cohort to optimize recognition and communication of EOL is needed to avoid unnecessary suffering. Level of evidence Level III/prognostic and epidemiological.
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trauma Surg Acute Care Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Trauma Surg Acute Care Open Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido