Citation

Jawa RS, Shapiro MJ, McCormack JE, Huang EC, Rutigliano DN, Vosswinkel JA. Am. J. Surg. 2015; 210(5): 814-821.

Affiliation

Division of Trauma, Department of Surgery, Stony Brook University School of Medicine, Stony Brook, NY, USA.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.amjsurg.2015.04.007

PMID

26116324

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.

CONCLUSION: An advanced directive indicating DNR is associated with adverse outcomes following trauma.

Language: en