Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage
- 08.06.2018
- Original Article
Erschienen in:
- Verfasst von
- Cora H. Ormseth
- Guido J. Falcone
- Sara D. Jasak
- David M. Mampre
- Audrey C. Leasure
- Laura C. Miyares
- David Y. Hwang
- Michael L. James
- Fernando D. Testai
- Kyra J. Becker
- David L. Tirschwell
- Carl D. Langefeld
- Daniel Woo
- Kevin N. Sheth
- Erschienen in
- Neurocritical Care | Ausgabe 3/2018
Abstract
Background
Prior studies of patients in the intensive care unit have suggested racial/ethnic variation in end-of-life decision making. We sought to evaluate whether race/ethnicity modifies the implementation of comfort measures only status (CMOs) in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH).
Methods
We analyzed data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a prospective cohort study specifically designed to enroll equal numbers of white, black, and Hispanic subjects. ICH patients aged ≥ 18 years were enrolled in ERICH at 42 hospitals in the USA from 2010 to 2015. Univariate and multivariate logistic regression analyses were implemented to evaluate the association between race/ethnicity and CMOs after adjustment for potential confounders.
Results
A total of 2705 ICH cases (912 black, 893 Hispanic, 900 white) were included in this study (mean age 62 [SD 14], female sex 1119 [41%]). CMOs patients comprised 276 (10%) of the entire cohort; of these, 64 (7%) were black, 79 (9%) Hispanic, and 133 (15%) white (univariate p < 0.001). In multivariate analysis, compared to whites, blacks were half as likely to be made CMOs (OR 0.50, 95% CI 0.34–0.75; p = 0.001), and no statistically significant difference was observed for Hispanics. All three racial/ethnic groups had similar mortality rates at discharge (whites 12%, blacks 9%, and Hispanics 10%; p = 0.108). Other factors independently associated with CMOs included age (p < 0.001), premorbid modified Rankin Scale (p < 0.001), dementia (p = 0.008), admission Glasgow Coma Scale (p = 0.009), hematoma volume (p < 0.001), intraventricular hematoma volume (p < 0.001), lobar (p = 0.032) and brainstem (p < 0.001) location and endotracheal intubation (p < 0.001).
Conclusions
In ICH, black patients are less likely than white patients to have CMOs. However, in-hospital mortality is similar across all racial/ethnic groups. Further investigation is warranted to better understand the causes and implications of racial disparities in CMO decisions.
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- Titel
- Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage
- Verfasst von
-
Cora H. Ormseth
Guido J. Falcone
Sara D. Jasak
David M. Mampre
Audrey C. Leasure
Laura C. Miyares
David Y. Hwang
Michael L. James
Fernando D. Testai
Kyra J. Becker
David L. Tirschwell
Carl D. Langefeld
Daniel Woo
Kevin N. Sheth
- Publikationsdatum
- 08.06.2018
- Verlag
- Springer US
- Erschienen in
-
Neurocritical Care / Ausgabe 3/2018
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961 - DOI
- https://doi.org/10.1007/s12028-018-0554-4
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