PMID: 3771981Nov 1, 1986Paper

The choice not to be resuscitated

Journal of the American Geriatrics Society
D A Schwartz, P Reilly

Abstract

We studied the use of the do not resuscitate (DNR) order among general medical patients. During the six-month study period, of 2431 admissions there were 95 patients (3.9%) declared DNR. Of 105 deaths, 69 (66%) occurred among DNR patients. Twenty-seven percent of the DNR patients left the hospital alive. In 90% of the cases the medical intern initiated the DNR discussion, and in 60% of the cases a decision was reached in less than 24 hours. Two-thirds of the DNR orders were consented to by family members, and one-third of all DNR orders had a discernible impact on nonresuscitative care. Less aggressive therapy accounted for 60% of these restrictions, whereas the remainder involved limitations in diagnostic evaluations. When compared with age- and sex-matched general adult inpatient control subjects, DNR patients were found to have longer hospitalizations (P = .01), be more likely to reside in a nursing home (RR = 4.2), have a metastatic neoplasm (RR = 3.6), and be admitted with an abnormal mental status (RR = 6.1) or urinary incontinence (RR = 2.9). These differences remained significant when we controlled for the presence of a metastatic neoplasm. Despite a high in-hospital mortality rate (73%), DNR patients were not admitted ...Continue Reading

References

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Citations

Feb 1, 1992·The American Journal of Medicine·K Wrenn, S L Brody
Jun 3, 2004·Resuscitation·Marja-Liisa LaakkonenKaisu H Pitkala
Jun 1, 1989·Journal of the American Geriatrics Society·A M FaderJ Escher
Aug 1, 1988·Journal of the American Geriatrics Society·M R Gillick
Jan 1, 1989·Journal of the American Geriatrics Society·D HavlirG K Rousseau
Jul 1, 1995·Heart & Lung : the Journal of Critical Care·D A Sherman, K Branum
Nov 1, 1990·Journal of the American Geriatrics Society·D J Murphy
Jan 1, 1993·Journal of the American Geriatrics Society·D J Luchins, P Hanrahan
Jan 27, 1999·Journal of the American Geriatrics Society·J R LevinD B Reuben
Feb 1, 1995·Journal of the American Geriatrics Society·F R Kellogg, A Ramos
Oct 2, 2013·Neurology Research International·Latha GantiAlejandro Rabinstein
Mar 15, 2014·The Journal of Nutrition, Health & Aging·L de DeckerO Beauchet
Sep 21, 1995·The New England Journal of Medicine·A FukauraM Adachi
Jul 3, 2007·The American Journal of Hospice & Palliative Care·Joseph Varon, Paul E Marik
Mar 1, 1989·Theoretical Medicine·D M High
Dec 1, 1993·Journal of Medical Ethics·J J van DeldenC W Looman
May 1, 1991·Journal of the American Geriatrics Society·D R BerlowitzM A Moskowitz
Nov 1, 1994·Journal of the American Geriatrics Society·N K ChoudhryP A Singer
Sep 1, 1993·Theoretical Medicine·R A PearlmanR M Arnold
Sep 1, 1990·Journal of the American Geriatrics Society·R M MeyersC J Waring
Sep 4, 1989·The Medical Journal of Australia·D P Stanley, D P Reid

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