Background
Methods
Data collection
Medical care
Propensity score matching
Sensitivity analysis
Statistical analysis
Results
DNRCC (n = 88) |
Pvaluec
| Non-DNR (n = 2,051) |
Pvalued
| DNRCC-Arrest (n = 188) | |
---|---|---|---|---|---|
Age | 63.61 ± 15.52 | <0.01 | 54.23 ± 17.76 | <0.01 | 66.83 ± 16.28 |
Sex (male) | 52 (59.09%) | 0.19 | 1065 (51.93%) | 0.82 | 96 (51.06%) |
APACHE II minus GCS | 23.60 ± 8.05 | <0.01 | 15.20 ± 6.83 | <0.01 | 21.39 ± 7.27 |
GCS | 7.68 ± 4.60 | <0.01 | 12.07 ± 4.00 | <0.01 | 10.57 ± 4.39 |
Length of stay in the ICU by hour | 91.99 ± 130.42 | 0.16 | 72.00 ± 86.21 | <0.01 | 120.04 ± 130.75 |
Length of stay in the hospital by hour | 155.47 ± 170.19 | 0.03 | 197.58 ± 205.09 | <0.01 | 256.77 ± 210.98 |
Admission delaye
| 34 (38.64%) | <0.01 | 463 (22.57%) | 0.03 | 56 (29.79%) |
Intubated during ICU stay | 56 (63.64%) | <0.01 | 552 (26.91%) | <0.01 | 73 (38.83%) |
Prior end-of-life decision documented | 6 (6.82%) | <0.01 | 43 (2.10%) | 0.15 | 7 (3.72%) |
Cared for by only one intensivistf
| 51 (57.95%) | 0.36 | 1288 (62.80%) | <0.01 | 86 (45.74%) |
Elixhauser comorbidity measuresg
| <0.01 ~ 0.97 | <0.01 ~ 0.91 | |||
Insurance type | <0.01 | <0.01 | |||
Private | 41 (46.59%) | 611 (29.79%) | 74 (39.36%) | ||
Medicare only | 11 (12.50%) | 257 (12.53%) | 38 (20.21%) | ||
Medicaid only | 14 (15.91%) | 506 (24.67%) | 34 (18.09%) | ||
Medicare and Medicaid | 17 (19.32%) | 316 (15.41%) | 29 (15.43%) | ||
None | 5 (5.68%) | 361 (17.60%) | 13 (6.91%) | ||
Source of admission to the ICU | 0.02 | 0.10 | |||
Emergency department | 53 (60.23%) | 1513 (73.77%) | 124 (65.96%) | ||
Floorh
| 31 (35.23%) | 413 (20.14%) | 53 (28.19%) | ||
Other ICU | 2 (2.27%) | 49 (2.39%) | 6 (3.19%) | ||
Outside hospital | 1 (1.14%) | 26 (1.27%) | 2 (1.06%) | ||
Miscellaneous/others | 1 (1.14%) | 50 (2.44%) | 3 (1.60%) | ||
Race/ethnicity | 0.47 | <0.01 | |||
White American | 60 (68.18%) | 1277 (62.26%) | 141 (75%) | ||
African American | 23 (26.14%) | 602 (29.35%) | 37 (19.68%) | ||
Other | 5 (5.68%) | 172 (8.39%) | 10 (5.32%) | ||
ICU admission diagnosisi
| <0.01 | <0.01 | |||
Medical-respiratory diseases | 37 (42.53%) | 587 (28.96%) | 74 (39.36%) | ||
Medical-gastrointestinal diseases | 6 (6.9%) | 321 (15.84%) | 23 (12.23%) | ||
Medical-cardiovascular diseases | 18 (20.69%) | 347 (17.12%) | 50 (26.60%) | ||
Medical-neurological diseases | 20 (22.99%) | 334 (16.48%) | 35 (18.62%) | ||
Other | 6 (6.9%) | 438 (21.61%) | 6 (3.19%) | ||
Daily cost of ICU stay | 7592 ± 7465 | 0.02 | 5691 ± 4578 | 0.16 | 5302 ± 3546 |
Daily cost of hospital stay | 5966 ± 7374 | <0.01 | 3191 ± 2033 | <0.01 | 3878 ± 3452 |
Daily discretionary cost of ICU stay | 2666 ± 3239 | 0.03 | 1878 ± 2416 | 0.77 | 1822 ± 2466 |
DNRCC and non-DNR patients
DNRCC (n = 88) | Non-DNR (n = 88) |
Pvalue | SD | |
---|---|---|---|---|
Patient characteristics | ||||
Age | 63.61 ± 15.52 | 64.01 ± 16.98 | 0.87 | -0.02 |
Sex (male) | 52 (59.09%) | 54 (61.36%) | 0.76 | -0.05 |
APACHE II minus GCS | 23.60 ± 8.05 | 23.31 ± 7.41 | 0.80 | 0.04 |
GCS | 7.68 ± 4.60 | 7.61 ± 4.33 | 0.92 | 0.02 |
Length of stay in the ICU by hour | 91.99 ± 130.42 | 107.74 ± 132.81 | 0.43 | -0.12 |
Length of stay in the hospital by hour | 155.47 ± 170.19 | 184.31 ± 161.66 | 0.25 | -0.17 |
Admission delayc
| 34 (38.64%) | 29 (32.95%) | 0.43 | 0.12 |
Intubated during ICU stay | 56 (63.64%) | 56 (63.64%) | 1.00 | 0 |
Prior end-of-life decision documented | 6 (6.82%) | 7 (7.95%) | 0.77 | -0.04 |
Cared for by only one intensivistd
| 51 (57.95%) | 52 (59.09%) | 0.88 | -0.02 |
Elixhauser comorbidity measurese
| - | - | 0.15 ~ 1.00 | -0.14 ~ 0.22 |
Insurance type | 0.78 | |||
Private | 41 (46.59%) | 41 (46.59%) | 0 | |
Medicare only | 11 (12.50%) | 7 (7.95%) | 0.15 | |
Medicaid only | 14 (15.91%) | 19 (21.59%) | 0.15 | |
Medicare and Medicaid | 17 (19.32%) | 17 (19.32%) | 0 | |
None | 5 (5.68%) | 4 (4.55%) | 0.05 | |
Source of admission to ICU | 0.88 | |||
Emergency department | 53 (60.23%) | 58 (65.91%) | -0.12 | |
Floorf
| 31 (35.23%) | 25 (28.41%) | 0.15 | |
Other ICU | 2 (2.27%) | 2 (2.27%) | 0 | |
Outside hospital | 1 (1.14%) | 1 (1.14%) | 0 | |
Miscellaneous/other | 1 (1.14%) | 2 (2.27%) | -0.09 | |
Race/ethnicity | 0.99 | |||
White American | 60 (68.18%) | 61 (69.32%) | -0.02 | |
African American | 23 (26.14%) | 22 (25%) | 0.03 | |
Other | 5 (5.68%) | 5 (5.68%) | 0 | |
ICU admission diagnosisg
| 0.97 | |||
Medical-respiratory diseases | 37 (42.53%) | 35 (40.70%) | 0.05 | |
Medical-gastrointestinal diseases | 6 (6.9%) | 5 (5.81%) | -0.10 | |
Medical-cardiovascular diseases | 18 (20.69%) | 16 (18.60%) | 0.06 | |
Medical-neurological diseases | 20 (22.99%) | 23 (26.74%) | -0.08 | |
Others | 6 (6.9%) | 7 (8.14%) | -0.05 | |
Medical care | ||||
Daily cost of ICU stay | 7592 ± 7465 | 6528 ± 4829 | 0.26 | |
Daily cost of hospital stay | 5966 ± 7374 | 4616 ± 3989 | 0.13 | |
Daily discretionary cost of ICU stay | 2666 ± 3239 | 2286 ± 2371 | 0.38 | |
Pharmacological/electrical cardioversion | 15 (17.05%) | 20 (22.73%) | 0.35 | |
Vasopressor | 36 (40.91%) | 23 (26.14%) | 0.04 | |
Intravenous antibiotics | 66 (75%) | 71 (80.68%) | 0.36 | |
Renal replacement therapy | 4 (4.55%) | 18 (20.45%) | <0.01 | |
Blood component transfusion | 25 (28.41%) | 26 (29.55%) | 0.87 | |
Central venous line placement | 36 (40.91%) | 45 (51.14%) | 0.17 | |
Pain control using morphine/fentanyl | 75 (85.23%) | 42 (47.73%) | <0.01 | |
Pastoral care | 42 (47.73%) | 30 (34.09%) | 0.07 | |
Hospice/palliative care consultation | 27 (30.68%) | 8 (9.09%) | <0.01 |
Before DNRCC was in effect (n = 88) | After DNRCC was in effect (n = 88) |
Pvalue | |||
---|---|---|---|---|---|
Provided | Not provided | Provided | Not provided | ||
Aggressive intervention | |||||
Pharmacological/electrical cardioversion | 14 (15.9%) | 74 (84.1%) | 2 (2.27%) | 86 (97.73%) | <0.01 |
Vasopressor | 36 (40.9%) | 52 (59.1%) | 0 (0%) | 88 (100%) | <0.01 |
Intravenous antibiotics | 66 (75%) | 22 (25%) | 8 (9.09%) | 80 (90.91%) | <0.01 |
Renal replacement therapy | 4 (4.54%) | 84 (95.46%) | 0 (0%) | 88 (100%) | 0.05 |
Blood component transfusion | 25 (28.4%) | 63 (71.6%) | 1 (1.13%) | 87 (98.87%) | <0.01 |
Central venous line placement | 36 (40.9%) | 52 (59.1%) | 6 (6.81%) | 82 (93.19%) | <0.01 |
Comfort care measure | |||||
Pain control using morphine/fentanyl | 35 (39.77%) | 53 (60.23%) | 75 (85.22%) | 13 (14.78%) | <0.01 |
Pastoral care | 22 (25%) | 66 (75%) | 34 (38.63%) | 54 (61.37%) | 0.02 |
Hospice/palliative care consultation | 5 (5.68%) | 83 (94.32%) | 24 (27.27%) | 64 (72.73%) | <0.01 |
DNRCC-Arrest and non-DNR patients
DNRCC-Arrest (n = 188) | Non-DNR (n = 188) |
Pvalue | SD | |
---|---|---|---|---|
Patient characteristics | ||||
Age | 66.83 ± 16.28 | 66.70 ± 14.92 | 0.93 | 0.01 |
Sex (male) | 96 (51.06%) | 97 (51.60%) | 0.92 | -0.01 |
APACHE II minus GCS | 21.39 ± 7.27 | 21.24 ± 6.61 | 0.79 | 0.02 |
GCS | 10.57 ± 4.39 | 10.91 ± 4.30 | 0.45 | -0.08 |
Length of stay in the ICU by hour | 120.04 ± 130.75 | 119.94 ± 151.84 | 0.99 | 0.001 |
Length of stay in the hospital by hour | 256.77 ± 210.98 | 254.32 ± 225.38 | 0.91 | 0.01 |
Admission delayc
| 56 (29.79%) | 59 (31.38%) | 0.74 | -0.04 |
Intubated during ICU stay | 73 (38.83%) | 67 (35.64%) | 0.52 | 0.07 |
Prior end-of-life decision documented | 7 (3.72%) | 8 (4.26%) | 0.79 | -0.03 |
Cared for by only one intensivistd
| 86 (45.74%) | 89 (47.34%) | 0.76 | -0.03 |
Elixhauser comorbidity measurese
| 0.13 ~ 1.00 | -0.14 ~ 0.16 | ||
Insurance type | 0.90 | |||
Private | 74 (39.36%) | 70 (37.23%) | 0.04 | |
Medicare only | 38 (20.21%) | 41 (21.81%) | -0.04 | |
Medicaid only | 34 (18.09%) | 38 (20.21%) | -0.05 | |
Medicare and Medicaid | 29 (15.43%) | 24 (12.77%) | 0.08 | |
None | 13 (6.91%) | 15 (7.98%) | -0.04 | |
Source of admission to ICU | 0.85 | |||
Emergency department | 124 (65.96%) | 118 (62.77%) | 0.07 | |
Floorf
| 53 (28.19%) | 54 (28.72%) | -0.01 | |
Other ICU | 6 (3.19%) | 10 (5.32%) | -0.11 | |
Outside hospital | 2 (1.06%) | 3 (1.60%) | -0.05 | |
Miscellaneous | 3 (1.60%) | 3 (1.60%) | 0 | |
Race/ethnicity | 0.81 | |||
White American | 141 (75%) | 137 (72.87%) | 0.07 | |
African American | 37 (19.68%) | 42 (22.34%) | -0.01 | |
Other | 10 (5.32%) | 9 (4.79%) | -0.11 | |
ICU admission diagnosis | 0.98 | |||
Medical-respiratory diseases | 74 (39.36%) | 77 (40.96%) | 0.07 | |
Medical-gastrointestinal diseases | 23 (12.23%) | 21 (11.17%) | -0.01 | |
Medical-cardiovascular diseases | 50 (26.60%) | 53 (28.19%) | -0.11 | |
Medical-neurological diseases | 35 (18.62%) | 32 (17.02%) | -0.05 | |
Other | 6 (3.19%) | 5 (2.66%) | 0 | |
Medical care | ||||
Daily cost of ICU stay | 5302 ± 3546 | 5915 ± 4358 | 0.14 | |
Daily cost of hospital stay | 3878 ± 3452 | 3605 ± 2505 | 0.38 | |
Daily discretionary cost of ICU stay | 1822 ± 2466 | 2018 ± 2312 | 0.43 | |
Pharmacological/electrical cardioversion | 42 (22.34%) | 40 (21.28%) | 0.80 | |
Vasopressor | 44 (23.40%) | 44 (23.40%) | 1.00 | |
Intravenous antibiotics | 138 (73.40%) | 149 (79.26%) | 0.18 | |
Renal replacement therapy | 16 (8.51%) | 16 (8.51%) | 1.00 | |
Blood component transfusion | 61 (32.45%) | 68 (36.17%) | 0.45 | |
Central venous line | 65 (34.57%) | 74 (39.36%) | 0.34 | |
Pain control using morphine/fentanyl | 68 (36.17%) | 79 (42.02%) | 0.25 | |
Pastoral care | 54 (28.72%) | 61 (32.45%) | 0.43 | |
Hospice/palliative care consultation | 15 (7.98%) | 12 (6.38%) | 0.55 |
Before DNRCC-Arrest came into effect (n = 188) | After DNRCC-Arrest came into effect (n = 188) |
Pvalue | |||
---|---|---|---|---|---|
Provided | Not provided | Provided | Not provided | ||
Aggressive intervention | |||||
Pharmacological/electrical cardioversion | 36 (19.14%) | 152 (80.86%) | 39 (20.74%) | 149 (79.26%) | 0.32 |
Vasopressor | 33 (17.55%) | 155 (82.45%) | 34 (18.08%) | 154 (81.92%) | 0.83 |
Intravenous antibiotics | 122 (64.89%) | 66 (35.11%) | 133 (70.74%) | 55 (29.26%) | 0.02 |
Renal replacement therapy | 12 (6.38%) | 176 (93.62%) | 12 (6.38%) | 176 (93.62%) | 1.00 |
Blood component transfusion | 42 (22.34%) | 146 (77.66%) | 43 (22.87%) | 145 (77.13%) | 0.87 |
Central venous line placement | 59 (31.38%) | 129 (68.62%) | 64 (34.04%) | 124 (65.96%) | 0.06 |
Comfort care measure | |||||
Pain control using morphine/fentanyl | 44 (23.4%) | 144 (76.6%) | 62 (32.97%) | 126 (67.03%) | <0.01 |
Pastoral care | 13 (6.91%) | 175 (93.09%) | 46 (24.46%) | 142 (75.54%) | <0.01 |
Hospice/palliative care consultation | 1 (0.53%) | 187 (99.47%) | 15 (7.97%) | 173 (92.03%) | <0.01 |