Do not resuscitate status, not age, affects outcomes after injury: an evaluation of 15,227 consecutive trauma patients.
Do not resuscitate status, not age, affects outcomes after injury: an evaluation of 15,227 consecutive trauma patients.
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DOI：
10.1097/ta.0b013e31828c4698
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发表时间：
2013-05
期刊：
影响因子：
--
通讯作者：
Holcomb JB
中科院分区：
文献类型：
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作者：
Adams SD;Cotton BA;Wade CE;Kozar RA;Dipasupil E;Podbielski JM;Gill BS;Duke JR;Adams PR;Holcomb JB
尽管年龄和损伤与死亡率和功能状态下降之间的关系已得到很好的描述，但住院患者死亡率研究传统上不包括DNR状态的分析。我们假设老年患者DNR状态的可能性增加会改变创伤中年龄调整的死亡率。创伤登记处查询了我们一级创伤中心（2005年1月至2008年12月）收治的成人患者，并按年龄分为8个年龄组。15-44岁由于缺乏变化而崩溃。我们通过单变量分析比较了年龄、病死率和DNR状态，并通过卡方分析比较了趋势（p<0.05）。15，227例成人患者入院，13%为老年患者（≥ 65岁），7%死亡。在75%的死亡病例中，DNR状态是已知的，其中42%的人在死亡时在图表上有积极的DNR订单。DNR可能性随着年龄的增长而增加（p < 0.05），从5%增加到18%。排除DNR后，所有年龄段的死亡率变异性显著降低（4%-7%）。由于医院之间的实施和意义不一致，创伤患者的DNR状态差异很大，连续几十年更有可能在死亡时有一个积极的DNR命令。当DNR患者从死亡率分析中排除时，年龄与死亡风险增加的相关性最小。将DNR患者纳入死亡率研究可能会扭曲这些分析，错误地表明复苏努力失败，而不是人道的决定，以限制受伤后的护理。
Despite a well-described association of age and injury with mortality and decreased functional status, inpatient mortality studies have traditionally not included analysis of DNR status. We hypothesized that the increased likelihood of DNR status in older patients alters age-adjusted mortality rates in trauma. The trauma registry was queried for adult patients admitted to our Level I trauma center (1/2005–12/2008) and divided into 8 age groups by decade. Ages 15–44 were collapsed due to lack of variation. We compared age, case fatality rate, and DNR status by univariate analysis and trends by Chi-square (p<0.05). 15,227 adult patients were admitted, 13% were elderly (≥ 65), and 7% died. DNR status was known in 75% of deaths, and 42% of those had active DNR orders on the chart at time of death. DNR likelihood increased with age (p < 0.05), from 5 to 18%. With DNRs excluded, mortality variability across all ages was markedly diminished (4%–7%). DNR status among trauma patients varies significantly, due to inconsistent implementation and meaning between hospitals, and successive decades are more likely to have an active DNR order at time of death. When DNR patients were excluded from mortality analysis, age was minimally associated with an increased risk of death. Inclusion of DNR patients within mortality studies likely skews those analyses, falsely indicating failed resuscitative efforts rather than humane decisions to limit care after injury.