%0 Journal Article
%T Early do-not-resuscitate orders in intracerebral haemorrhage; frequency and predictive value for death and functional outcome. A retrospective cohort study
%A Marco Brizzi
%A Kasim Abul-Kasim
%A Mattis Jalakas
%A Eufroina Selariu
%A H¨¦l¨¨ne Pessah-Rasmussen
%A Elisabet Zia
%J Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
%D 2012
%I BioMed Central
%R 10.1186/1757-7241-20-36
%X In 197 consecutive ICH patients admitted to Sk£¿ne University Hospital, Malm£¿, Sweden, between January 2007 and June 2009, information of the presence of DNR orders within 48£¿hours, clinical and radiological characteristics was retrieved by review of patient medical journal and computed tomography scans. Determinants of DNR-orders, one-month case fatality and bad functional outcome (modified Rankin Scale, grade 4¨C6) were assessed by logistic regression analysis.DNR orders were made in 41% of the cases. After adjustment for confounding factors, age£¿¡İ£¿75£¿years (Odds Ratio (95% confidence interval) 4.2(1.8-9.6)), former stroke (5.1(1.9-3.1)), Reaction Level Scale grade 2¨C3 and 4 (7.0(2.8-17.5) and (4.1(1.2-13.5), respectively) and intraventricular haemorrhage (3.8(1.6-9.4)) were independent determinants of early DNR orders. Independent predictors of one-month case fatality was age£¿¡İ£¿75£¿years (3.7(1.4-9.6)) volume£¿¡İ£¿30£¿ml (3.5(1.3-9.6)) and DNR orders (3.5(1.5-8.6)). Seizure (6.0(1.04-34.2) and brain stem hemorrhage (8.0(1.1-58.4)) were related to bad functional outcome, whereas early DNR order was not (3.5(0.99-12.7)).Well known prognostic factors are determinants for DNR orders, however DNR orders are independently related to one-month case fatality. In addition to improvements of the local routines, we welcome a change of attitude with an enhanced awareness of the definition of, and a more careful approach with respect to DNR orders.
%K Intracerebral haemorrhage
%K Prognosis
%K Functional outcome
%K Mortality
%K Do not resuscitate orders
%U http://www.sjtrem.com/content/20/1/36/abstract