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Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

Abstract：

OBJECTIVE:To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. DESIGN:Population-based surveillance. SETTING:Corpus Christi, Texas. PATIENTS:All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ("any do-not-resuscitate") and within 24 hrs of presentation ("early do-not-resuscitate"), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, modified Charlson Index, and admission from a nursing home. A total of 270 cases of intracerebral hemorrhage from 2000-2003 were analyzed. Mexican-Americans were younger and had a higher Glasgow Coma Scale than non-Hispanic whites. Mexican-Americans were half as likely as non-Hispanic whites to have early do-not-resuscitate orders in unadjusted analysis (odds ratio 0.45, 95% confidence interval 0.27, 0.75), although this association was not significant when adjusted for age (odds ratio 0.61, 95% confidence interval 0.35, 1.06) and in the fully adjusted model (odds ratio 0.75, 95% confidence interval 0.39, 1.46). Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders written at any time point (odds ratio 0.37, 95% confidence interval 0.23, 0.61). Adjustment for age alone attenuated this relationship although it retained significance (odds ratio 0.49, 95% confidence interval 0.29, 0.82). In the fully adjusted model, Mexican-Americans were less likely than non-Hispanic whites to use do-not-resuscitate orders at any time point, although the 95% confidence interval included one (odds ratio 0.52, 95% confidence interval 0.27, 1.00). CONCLUSIONS:Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders after intracerebral hemorrhage although the association was attenuated after adjustment for age and other confounders. The persistent trend toward less frequent use of do-not-resuscitate orders in Mexican-Americans suggests that further study is warranted.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Zahuranec DB,Brown DL,Lisabeth LD,Gonzales NR,Longwell PJ,Smith MA,Garcia NM,Morgenstern LB

doi

10.1097/CCM.0b013e3181a56755

subject

Has Abstract

pub_date

2009-10-01 00:00:00

pages

2807-11

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

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Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.