Lillemoe Kaitlyn, Lord Aaron, Torres Jose, Ishida Koto, Czeisler Barry, Lewis Ariane
Department of Neurology, NYU Langone Medical Center, New York, NY, USA.
Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
Neurohospitalist. 2020 Jul;10(3):168-175. doi: 10.1177/1941874419873812. Epub 2019 Sep 22.
We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage.
We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status.
Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission ( 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients ( .01) and less likely to be seen by palliative care ( .004). Patients with less aggressive code status had higher median APACHE II scores ( .008) and were more likely to have active cancer ( .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity.
Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.
我们探讨了非创伤性颅内出血后与入院及出院代码状态相关的因素。
我们提取了2013年1月1日至2016年3月1日期间入住我院的非创伤性脑出血或蛛网膜下腔出血患者的数据，这些患者出院时改良Rankin量表（mRS）评分为4至6分。我们根据入院及出院代码状态对数据进行了回顾。
在88例符合纳入标准的患者中，6例（7%）入院时为不进行心肺复苏（DNR）（aDNR）。入院时不进行心肺复苏的患者明显比入院时为完全代码状态的患者年龄大（P = 0.04）。入院代码状态与性别、婚姻状况、活动性癌症、病前mRS、入院格拉斯哥昏迷量表（GCS）、急性生理与慢性健康状况评估II（APACHE II）评分或出血严重程度之间无显著差异。出院时，66例（75%）患者为完全代码状态（dFULL），11例（13%）为DNR（dDNR），11例（13%）为舒适护理。非裔美国人和西班牙裔患者比亚洲或白人患者更有可能处于dFULL状态（P = 0.01），且接受姑息治疗的可能性更小（P = 0.004）。代码状态较不积极的患者APACHE II评分中位数更高（P = 0.008），且更有可能患有活动性癌症（P = 0.06）。出院代码状态与性别、年龄、婚姻状况、病前mRS、出院GCS或出血严重程度之间无显著差异。
非创伤性颅内出血后代码状态的限制似乎与年龄较大、白种人、较差的APACHE II评分和活动性癌症有关。颅内出血后姑息治疗的作用以及治疗限制和降级方面的种族差异值得进一步探讨。
