title: "Do not resuscitate" orders among deceased patients who received acute neurological care: an observation analysis.
abstract: There were many reports about the "do not resuscitate" (DNR) order while practicing in the critical care units and conducting hospice affairs but limited in the neurological issues. This study investigated the possible flaws in the execution of the DNR order among patients who received acute neurological care in Taiwan. Over a 3-year period, we retrospectively reviewed the medical records of 77 deceased patients with neurological conditions for DNR orders. Registry and analysis works included demography, hospital courses, DNR data, and clinical usefulness of the lab and image examinations. Sixty-seven DNR orders were requested by the patients' families, and more than half were signed by the patients' children or grandchildren. The main DNR items were chest compression, cardiac defibrillation, and pacemaker use, although several DNR patients received resuscitation. The mean duration from the coding date to death was 7.6 days. Two-thirds of the patients with DNR requests remained in the intensive care unit, with a mean stay of 6.9 days. Several patients underwent regular roentgenography and blood tests on the day of their death, despite their DNR orders. Hospital courses and DNR items may be valuable information on dealing with the patients with DNR orders. The results of this study also suggest the public education about the DNR orders implemented for neurological illnesses.
authors.affiliation: From the School of Medicine, Fu Jen Catholic University (THC, VW); Department of Neurology (THC, VW), and Department of Family Medicine (TJH), Cardinal Tien, College of Medicine, Hospital, Xindian District, New Taipei City, Taiwan.
authors.forename: Tzu-Hao
authors.initials: TH
authors.lastname: Chao
authors.forename: Tien-Jen
authors.initials: TJ
authors.lastname: Hsieh
authors.forename: Vinchi
authors.initials: V
authors.lastname: Wang
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001800:Blood Specimen Collection / Q000706:statistics & numerical data; D002423:Cause of Death; D005260:Female; D017051:Hospice Care; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016224:Living Wills / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology*; D011859:Radiography / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult