[Before and after implementation of do-not-resuscitate orders in a stroke unit].

BACKGROUND

In Norway, few studies have been done to map the extent of do-not-resuscitate (DNR) orders and the consequence for patients (treatment and outcome).

MATERIAL AND METHODS

All patients with DNR orders, referred to the stroke unit of Akershus University Hospital during the year 2005, were identified and data on treatment and outcome were recorded.

RESULTS

A DNR order was found for 79 of 855 (9 %) patients (mean age 80 years [SD 9]). Reasons for referral to hospital were: cerebral infarction (49 [62 %] patients), intracerebral haemorrhage (28 [35 %] patients), and other diseases (2 [3 %] patients). Mean NIH Stroke Scale was 19 (SD 6) (scale 0 - 42; 0 in score meaning no stroke related symptoms). Hospital mortality was 39/79 (49 %). Apart from once, all decisions regarding withholding and/or withdrawing life-sustaining treatment were taken in the aftermath of a DNR order. For 43 patients (54 %), treatment was limited in some way and hospital mortality for this group was 27/43 (63 %). Mortality was 12/36 (33 %) for those who had full treatment. 45 patients (57 %) with a DNR order had a bacterial infection and 32 of them were treated with antibiotics (71 %).

INTERPRETATION

Patients with DNR orders were old and had had severe stroke. Treatment was rarely withheld despite high morbidity and mortality among the patients.