Early care limitations independently predict mortality after intracerebral hemorrhage
- 15 May 2007
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 68 (20), 1651-1657
- https://doi.org/10.1212/01.wnl.0000261906.93238.72
Abstract
Objective: Intracerebral hemorrhage (ICH) is associated with a high early mortality rate. We examined the impact of early do not resuscitate (DNR) orders and other limitations in aggressive care on mortality after ICH in a community-based study. Methods: Cases of spontaneous ICH from 2000 to 2003 were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project, with deaths ascertained through 2005. Charts were reviewed for early (Results: Of 18,393 subjects screened for cerebrovascular disease, 270 non-traumatic ICH cases were included. Cumulative mortality risk was 0.43 at 30 days and 0.55 over the study course. Early C-DNR was noted in 34% of cases and was associated with a doubling in the hazard of death both at 30 days (hazard ratio [HR] 2.17, 95% CI 1.38, 3.41) and at end of follow-up (HR 1.92, 95% CI 1.29, 2.87) despite adjustment for age, gender, ethnicity, Glasgow Coma Scale, ICH volume, intraventricular hemorrhage, and infratentorial hemorrhage. Conclusions: Early care limitations are independently associated with both short- and long-term all-cause mortality after intracerebral hemorrhage (ICH) despite adjustment for expected predictors of ICH mortality. Physicians should carefully consider the effect of early limitations in aggressive care to avoid limiting care for patients who may survive their acute illness.Keywords
This publication has 24 references indexed in Scilit:
- Stroke Burden in Mexican Americans: The Impact of Mortality Following StrokeAnnals of Epidemiology, 2006
- Excess Stroke in Mexican Americans Compared with Non-Hispanic Whites: The Brain Attack Surveillance in Corpus Christi ProjectAmerican Journal of Epidemiology, 2004
- Hospital Usage of Early Do-Not-Resuscitate Orders and Outcome After Intracerebral HemorrhageStroke, 2004
- Functional recovery following rehabilitation after hemorrhagic and ischemic strokeArchives of Physical Medicine and Rehabilitation, 2003
- Impact of a Neuroscience Intensive Care Unit on Neurosurgical Patient Outcomes and Cost of CareJournal of Neurosurgical Anesthesiology, 2001
- The ICH ScoreStroke, 2001
- Do Patients Die Because They Have DNR Orders, or Do They Have DNR Orders Because They Are Going to Die?Medical Care, 1999
- Practice parameters for determining brain death in adultsNeurology, 1995
- Do-not-resuscitate orders in acute strokeNeurology, 1995
- Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality.Stroke, 1993