tetano
Editor, Senior Moderator
Chest
. 2023 Sep 29;S0012-3692(23)05546-0.
doi: 10.1016/j.chest.2023.09.024. Online ahead of print. Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the Coronavirus Disease 2019 Pandemic
Gina M Piscitello[SUP] 1 [/SUP], William F Parker[SUP] 2 [/SUP]
Affiliations
Background: At the beginning of the COVID-19 pandemic, it was unclear whether performing cardiopulmonary resuscitation on COVID-19 patients would be effective or increase COVID-19 transmission to health care workers.
Research question: Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to healthcare workers improved?
Study design and methods: This cross-sectional study assessed DNR orders for all adult patients admitted to intensive care units at two academic medical centers in Chicago, Illinois between April 2020 to April 2021. DNR orders by COVID-19 status were assessed using risk adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness.
Results: The study population of 3070 critically ill patients were 46% Black, 53% male, with median age (IQR) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs. 29% vs. 23%, p=0.006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in COVID-19 patients in the non-propensity score matched (n=3070; aOR 2.01, 95% CI 1.64-2.38) and propensity score matched (n=1118; aOR 1.91, 95% CI 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for COVID-19 patients than non-COVID-19 patients during all months of the study period (difference in prevalence over time p=0.751).
Interpretation: In this multihospital study, DNR orders remained persistently higher for COVID-19 patients versus non-COVID-19 patients with similar severity of illness during the first year of the pandemic. Identifying the specific reasons why DNR orders remained persistently elevated for COVID-19 patients should be assessed in future studies, as these changes may continue to affect COVID-19 patient care and outcomes.
Keywords: COVID-19; do-not-resuscitate; health disparities.
. 2023 Sep 29;S0012-3692(23)05546-0.
doi: 10.1016/j.chest.2023.09.024. Online ahead of print. Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the Coronavirus Disease 2019 Pandemic
Gina M Piscitello[SUP] 1 [/SUP], William F Parker[SUP] 2 [/SUP]
Affiliations
- PMID: 37778695
- DOI: 10.1016/j.chest.2023.09.024
Background: At the beginning of the COVID-19 pandemic, it was unclear whether performing cardiopulmonary resuscitation on COVID-19 patients would be effective or increase COVID-19 transmission to health care workers.
Research question: Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to healthcare workers improved?
Study design and methods: This cross-sectional study assessed DNR orders for all adult patients admitted to intensive care units at two academic medical centers in Chicago, Illinois between April 2020 to April 2021. DNR orders by COVID-19 status were assessed using risk adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness.
Results: The study population of 3070 critically ill patients were 46% Black, 53% male, with median age (IQR) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs. 29% vs. 23%, p=0.006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in COVID-19 patients in the non-propensity score matched (n=3070; aOR 2.01, 95% CI 1.64-2.38) and propensity score matched (n=1118; aOR 1.91, 95% CI 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for COVID-19 patients than non-COVID-19 patients during all months of the study period (difference in prevalence over time p=0.751).
Interpretation: In this multihospital study, DNR orders remained persistently higher for COVID-19 patients versus non-COVID-19 patients with similar severity of illness during the first year of the pandemic. Identifying the specific reasons why DNR orders remained persistently elevated for COVID-19 patients should be assessed in future studies, as these changes may continue to affect COVID-19 patient care and outcomes.
Keywords: COVID-19; do-not-resuscitate; health disparities.