title: Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage.
abstract: OBJECTIVE
  Studies show that women are more likely to receive do-not-resuscitate (DNR) orders after acute medical illnesses than men. However, the sex differences in the use of DNR orders after acute intracerebral hemorrhage (ICH) have not been described.
  
  
  METHODS
  We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were performed to test for associations between female sex and early (<24 hours of presentation) DNR orders.
  
  
  RESULTS
  A total of 372 consecutive ICH patients without preexisting DNR orders were studied. Overall, 82 (22%) patients had early DNR orders after being hospitalized with ICH. In the fully adjusted model, early DNR orders were more likely in women (odds ratio, 3.18; 95% confidence interval, 1.51-6.70), higher age (odds ratio, 1.09 per year; 95% confidence interval, 1.05-1.12), larger ICH volume (odds ratio, 1.01 per cm(3); 95% confidence interval, 1.01-1.02), and lower initial GCS score (odds ratio, 0.76 per point; 95% confidence interval, 0.69-0.84). Early DNR orders were less likely when the patients were transferred from another hospital (odds ratio, 0.28, 95% confidence interval, 0.11-0.76).
  
  
  CONCLUSIONS
  Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.
authors: From The Queen's Medical Center, Honolulu, HI (K.N., M.A.V., T.B.S., M.A.K., S.M.A., C.W.J.C.); Departments of Medicine (K.N., T.B.S., M.A.K., C.W.J.C.), Native Hawaiian Health (T.B.S.), and Surgery (C.W.J.C.), John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; and the Department of Neurology and Neurosurgery, University of California, San Francisco, CA (J.C.H.).
authors: Kazuma
authors: K
authors: Nakagawa
authors: Megan A
authors: MA
authors: Vento
authors: Todd B
authors: TB
authors: Seto
authors: Matthew A
authors: MA
authors: Koenig
authors: Susan M
authors: SM
authors: Asai
authors: Cherylee W J
authors: CW
authors: Chang
authors: J Claude
authors: JC
authors: Hemphill
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012737:Sex Factors; D062606:Tertiary Care Centers
keywords: intracerebral hemorrhage; sex differences; terminal care
references: Neurology. 2010 Aug 17;75(7):626-33
references: 20610832
references: Arch Intern Med. 1995 Oct 23;155(19):2056-62
references: 7575064
references: Stroke. 2004 May;35(5):1130-4
references: 15044768
references: J Trauma. 2006 Jan;60(1):193-7; discussion 197-8
references: 16456455
references: Arch Intern Med. 1997 Sep 8;157(16):1841-7
references: 9290543
references: Arch Intern Med. 2004 Apr 12;164(7):776-83
references: 15078648
references: Neurology. 2007 May 15;68(20):1651-7
references: 17502545