title: 'Do Not Attempt Resuscitation' (DNAR) decisions in patients with femoral fractures: modification, clinical management and outcome.
abstract: BACKGROUND
  increased provision of orthogeriatric expertise for patients with femoral fractures has led to implementation of 'Do Not Attempt Resuscitation' (DNAR) decisions prior to anaesthesia and surgery for fixation of their fractures. Review and modification of the DNAR decision by the medical team is necessary before surgery and is recommended by guidelines from the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the General Medical Council.
  
  
  METHODS
  over a 17-month period, DNAR decisions were already present or were implemented for the first time in 22 patients prior to scheduled surgical fixation of their femoral fractures. Data were collected prospectively on each patient's management, including modification of their DNAR decision, and outcome at 30 days and 1 year.
  
  
  RESULTS
  two patients died prior to surgery. In eight of the 20 patients who underwent surgical fixation, there was no documentation regarding the status of the DNAR decision in the perioperative period. The 30-day mortality rate for those undergoing surgery was 15% (3/20). At 1 year, eight patients survived with six living in their own homes.
  
  
  CONCLUSIONS
  despite the favourable outcomes for hip fracture patients with pre-existing DNAR decisions, this audit showed inadequate review and documentation of the DNAR decision in advance of surgery.
authors: Department of Anaesthesia (A Block Theatres), Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK. michael.mcbrien@btinternet.com
authors: Michael E
authors: ME
authors: McBrien
authors: Alison
authors: A
authors: Kavanagh
authors: Gary
authors: G
authors: Heyburn
authors: James R M
authors: JR
authors: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D004282:Documentation; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016414:Resuscitation Orders; D013997:Time Factors; D016896:Treatment Outcome