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08.06.2018 | Original Article

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

Erschienen in: Neurocritical Care | Ausgabe 3/2018

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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.

Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56:766–72.CrossRefPubMed

Hwang DY, Dell CA, Sparks MJ, et al. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology. 2016;86:126–33.CrossRefPubMedPubMedCentral

Cai X, Robinson J, Muehlschlegel S, et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocrit Care. 2015;23:131–41.CrossRefPubMedPubMedCentral

Holloway RG, Benesch CG, Burgin WS, Zentner JB. Prognosis and decision making in severe stroke. JAMA. 2005;294:725–33.CrossRefPubMed

Cooper Z, Rivara FP, Wang J, MacKenzie EJ, Jurkovich GJ. Racial disparities in intensity of care at the end-of-life: are trauma patients the same as the rest? J Health Care Poor Underserved. 2012;23:857–74.CrossRefPubMed

Shepardson LB, Gordon HS, Ibrahim SA, Harper DL, Rosenthal GE. Racial variation in the use of do-not-resuscitate orders. J Gen Intern Med. 1999;14:15–20.CrossRefPubMedPubMedCentral

Bardach N, Zhao S, Pantilat S, Johnston SC. Adjustment for do-not-resuscitate orders reverses the apparent in-hospital mortality advantage for minorities. Am J Med. 2005;118:400–8.CrossRefPubMed

Qureshi AI, Adil MM, Suri MF. Rate of use and determinants of withdrawal of care among patients with subarachnoid hemorrhage in the United States. World Neurosurg. 2014;82:e579–84.CrossRefPubMed

Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit. Crit Care Med. 2001;29:1792–7.CrossRefPubMed

10.

Rubin MA, Dhar R, Diringer MN. Racial differences in withdrawal of mechanical ventilation do not alter mortality in neurologically injured patients. J Crit Care. 2014;29:49–53.CrossRefPubMed

11.

Choi HA, Fernandez A, Jeon SB, et al. Ethnic disparities in end-of-life care after subarachnoid hemorrhage. Neurocrit Care. 2015;22:423–8.CrossRefPubMed

12.

Woo D, Rosand J, Kidwell C, et al. The ethnic/racial variations of intracerebral hemorrhage (ERICH) study protocol. Stroke. 2013;44:e120–5.PubMed

13.

Sheth KN, Martini SR, Moomaw CJ, et al. Prophylactic antiepileptic drug use and outcome in the ethnic/racial variations of intracerebral hemorrhage study. Stroke. 2015;46:3532–5.CrossRefPubMedPubMedCentral

14.

Siddiqui FM, Langefeld CD, Moomaw CJ, et al. Use of statins and outcomes in intracerebral hemorrhage patients. Stroke. 2017;48:2098–104.CrossRefPubMedPubMedCentral

15.

Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–7.CrossRefPubMed

16.

Rost NS, Smith EE, Chang Y, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39:2304–9.CrossRefPubMed

17.

Zurasky JA, Aiyagari V, Zazulia AR, Shackelford A, Diringer MN. Early mortality following spontaneous intracerebral hemorrhage. Neurology. 2005;64:725–7.CrossRefPubMed

18.

Zahuranec DB, Brown DL, Lisabeth LD, et al. Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. Crit Care Med. 2009;37:2807–11.CrossRefPubMedPubMedCentral

19.

Hanchate A, Kronman AC, Young-Xu Y, Ash AS, Emanuel E. Racial and ethnic differences in end-of-life costs: why do minorities cost more than whites? Arch Intern Med. 2009;169:493–501.CrossRefPubMedPubMedCentral

20.

Crawley L, Payne R, Bolden J, Payne T, Washington P, Williams S. Palliative and end-of-life care in the African American community. JAMA. 2000;284:2518–21.CrossRefPubMed

21.

Rhodes RL, Elwood B, Lee SC, Tiro JA, Halm EA, Skinner CS. The desires of their hearts: the multidisciplinary perspectives of African Americans on end-of-life care in the African American community. Am J Hosp Palliat Care. 2017;34:510–7.CrossRefPubMed

22.

Johnson KS, Kuchibhatla M, Tulsky JA. What explains racial differences in the use of advance directives and attitudes toward hospice care? J Am Geriatr Soc. 2008;56:1953–8.CrossRefPubMedPubMedCentral

23.

Rhodes RL, Batchelor K, Lee SC, Halm EA. Barriers to end-of-life care for African Americans from the providers’ perspective: opportunity for intervention development. Am J Hosp Palliat Care. 2015;32:137–43.CrossRefPubMed

24.

Yancu CN, Farmer DF, Leahman D. Barriers to hospice use and palliative care services use by African American adults. Am J Hosp Palliat Care. 2010;27:248–53.CrossRefPubMed

25.

Noh H, Schroepfer TA. Terminally ill African American elders’ access to and use of hospice care. Am J Hosp Palliat Care. 2015;32:286–97.CrossRefPubMed

26.

Welch LC, Teno JM, Mor V. End-of-life care in black and white: race matters for medical care of dying patients and their families. J Am Geriatr Soc. 2005;53:1145–53.CrossRefPubMed

27.

Smith-Howell ER, Hickman SE, Meghani SH, Perkins SM, Rawl SM. End-of-Life decision making and communication of bereaved family members of African Americans with serious illness. J Palliat Med. 2016;19:174–82.CrossRefPubMedPubMedCentral

28.

Faigle R, Marsh EB, Llinas RH, Urrutia VC, Gottesman RF. Race-specific predictors of mortality in intracerebral hemorrhage: differential impacts of intraventricular hemorrhage and age among blacks and whites. J Am Heart Assoc 2016; 5:1–8.

29.

Flaherty ML, Woo D, Haverbusch M, et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke. 2005;36:934–7.CrossRefPubMed

30.

Cruz-Flores S, Rabinstein A, Biller J, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:2091–116.CrossRefPubMed

31.

James ML, Grau-Sepulveda MV, Olson DM, et al. Insurance status and outcome after intracerebral hemorrhage: findings from get with the guidelines-stroke. J Stroke Cerebrovasc Dis. 2014;23:283–92.CrossRefPubMed

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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Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage