Fan Ju-Sing, Huang Hsien-Hao, Chen Yen-Chia, How Chorng-Kuang, Yen David Hung-Tsang
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Am J Emerg Med. 2017 Dec;35(12):1850-1854. doi: 10.1016/j.ajem.2017.06.016. Epub 2017 Jun 10.
To explore the determinant factors and prognostic significance of emergency department do-not-resuscitate (ED-DNR) orders for patients with spontaneous intracerebral hemorrhage (SICH).
Consecutive adult SICH patients treated in our ED from January 1, 2012 to December 31, 2016 were selected as the eligible cases from our hospital's stroke database. Patients' information was comprehensively reviewed from the database and medical and nursing charts. ED-DNR orders were defined as DNR orders written during ED stay. Multiple logistic regression analysis was used to identify significant determinants of ED-DNR orders. Thirty- and 90-day neurological outcomes were analyzed to test the prognosis impact of ED-DNR orders.
Among 835 enrolled patients, 112 (12.1%) had ED-DNR orders. Significant determinant factors of ED-DNR orders were age, ambulatory status before the event, brain computed tomography findings of midline shift, intraventricular extension, larger hematoma size, and ED arrival GCS ≤8. Patients with and without ED-DNR orders had a similar 30-day death rate if they had the same initial ICH score point. During 30 to 90days, patients with ED-DNR orders had a significantly increased mortality rate. However, the rate of improvement in neurological status between the two groups was not significantly different.
Older and sicker SICH patients had higher rate of ED-DNR orders. The mortality rates between patients with and without ED-DNR orders for each ICH score point were not significantly different. During the 30-to-90-day follow-up, the rates of neurological improvement in both groups were similar.
探讨自发性脑出血（SICH）患者急诊科不进行心肺复苏（ED-DNR）医嘱的决定因素及预后意义。
从我院卒中数据库中选取2012年1月1日至2016年12月31日在我院急诊科接受治疗的连续性成年SICH患者作为符合条件的病例。从数据库以及医疗和护理记录中全面回顾患者信息。ED-DNR医嘱定义为在急诊科停留期间开具的DNR医嘱。采用多因素logistic回归分析确定ED-DNR医嘱的重要决定因素。分析30天和90天的神经功能结局，以检验ED-DNR医嘱对预后的影响。
在835例纳入患者中，112例（12.1%）有ED-DNR医嘱。ED-DNR医嘱的重要决定因素包括年龄、事件发生前的活动状态、脑计算机断层扫描中线移位、脑室内扩展、血肿较大以及急诊科就诊时格拉斯哥昏迷量表（GCS）评分≤8。初始脑出血（ICH）评分相同的有和没有ED-DNR医嘱的患者30天死亡率相似。在30至90天期间，有ED-DNR医嘱的患者死亡率显著增加。然而，两组神经功能状态改善率无显著差异。
年龄较大且病情较重的SICH患者ED-DNR医嘱率较高。每个ICH评分点有和没有ED-DNR医嘱的患者死亡率无显著差异。在30至90天的随访期间，两组神经功能改善率相似。
