Quantifying the Mortality Impact of Do-Not-Resuscitate Orders in the ICU.
OBJECTIVE
We quantified the 28-day mortality effect of preexisting do-not-resuscitate orders in ICUs.


METHODS
Longitudinal, retrospective study of patients admitted to five ICUs at a tertiary university medical center (Beth Israel Deaconess Medical Center, BIDMC, Boston, MA) between 2001 and 2008.


METHODS
None.


METHODS
Two cohorts were defined: patients with do not resuscitate advance directives on day 1 of ICU admission and a control group comprising patients with no limitations of level of care on ICU day 1 (full code).


RESULTS
The primary outcome was mortality at 28 days after ICU admission. Of 19,007 ICU patients, 1,239 patients (6.5%) had a do-not-resuscitate order on the first day of ICU admission and survived 48 hours in the ICU. We matched those do-not-resuscitate patients with 2,402 patients with full-code status. Twenty-eight day and 1-year mortality were both significantly higher in the do-not-resuscitate group (33.9% vs 18.4% and 60.7% vs 40.2%; p < 0.001, respectively).


CONCLUSIONS
Do-not-resuscitate status is an independent risk factor for ICU mortality. This may reflect severity of illness not captured by other clinical factors, but the perceptions of the treating team related to do-not-resuscitate status could also be causally responsible for increased mortality in patients with do-not-resuscitate status.
1Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. 2Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. 3Intensive Care Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia. 4The Harvard-MIT Division of Health Sciences & Technology, Massachusetts Institute of Technology, Cambridge, MA. 5Institute for Infocomm Research, Agency for Science, Technology and Research, Singapore. 6Center for Quality and the Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. 7Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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Matthew
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Mengling
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Ronen
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Toledano
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Michael D
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Clardy
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Celi
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Novack
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012307:Risk Factors