To describe the variation in frequency of do-not-resuscitate (DNR) orders in 42 US ICUs and to examine the relationship between published guidelines and qualitative observations about terminal care in 9 ICUs.
Prospective inception cohort.
Forty-two ICUs in 40 US hospitals with more than 200 beds : 26 randomly selected and 14 large tertiary-care volunteers.
A consecutive sample of 17,440 ICU admissions during 1988 to 1990.
We used age, race, comorbid conditions, disease, functional status, and acute physiology score on ICU day 1 to predict the likelihood of a DNR order for each patient.
A cross-validated model was then used to predict variations in the risk of an ICU DNR order from 0 to 45% (area under receiver operating characteristic curve=0.9).
The model was then used to compare aggregate observed with predicted frequency of ICU DNR orders.
Finally, we compared observations of DNR practices by a team of clinical and organizational researchers at 9 of the 42 ICUs with published guidelines and risk-adjusted DNR frequency : 1,577 admissions (9%) had DNR orders written in the ICU (range, 1.5 to 22%). The ICU site was a significant (p<0.0001) predictor of variance in the patient level model.
DNR orders were written significantly (p<0.05) less frequently than predicted in 5 and more frequently than predicted in 3 of 42 ICUs.
Mots-clés Pascal : Réanimation cardiocirculatoire, Soin intensif, Etats Unis, Amérique du Nord, Amérique, Ethique, Décision, Arrêt traitement, Homme
Mots-clés Pascal anglais : Intensive cardiocirculatory care, Intensive care, United States, North America, America, Ethics, Decision, Withdrawal, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0020755
Code Inist : 002B27B01. Création : 21/05/1997.