title: Preadmission Do Not Resuscitate advanced directive is associated with adverse outcomes following acute traumatic injury.
abstract: BACKGROUND
  Do Not Resuscitate (DNR) orders have been associated with poor outcomes in surgical patients. There is limited literature on admitted trauma patients with advanced directives indicating DNR status before admission (preadmission DNR [PADNR]).
  
  
  METHODS
  A retrospective review of the trauma registry of a suburban county was carried out for admitted trauma patients with age ≥41 years, who were admitted between 2008 and 2013.
  
  
  RESULTS
  Of 7,937 admitted patients, 327 had a preadmission advanced directive indicating DNR. PADNR patients were significantly older (87 vs 69 years), with more frequent comorbidities, and were more often admitted after a fall (94.2% vs 65.8%). PADNR patients had a higher Injury Severity Score (14 vs 11). They also had significantly increased rates of pneumonia, sepsis, myocardial infarction, and death (33.6% vs 5.9%). On multivariate logistic regression, the presence of a preadmission advanced directive indicating DNR status was independently associated with a 5.2-fold increased odds of mortality.
  
  
  CONCLUSIONS
  An advanced directive indicating DNR is associated with adverse outcomes following trauma.
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA. Electronic address: Randeep.jawa@stonybrookmedicine.edu.
authors.forename: Randeep S
authors.initials: RS
authors.lastname: Jawa
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Shapiro
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: McCormack
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Huang
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Rutigliano
authors.affiliation: Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Vosswinkel
mesh_terms: D015998:Abbreviated Injury Scale; D000058:Accidental Falls / Q000706:statistics & numerical data; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009518:New York / Q000453:epidemiology; D010343:Patient Admission; D011014:Pneumonia / Q000453:epidemiology; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality* / Q000601:surgery
keywords: DNR; Do Not Resuscitate; Injury; Outcome; Trauma