Patient and hospital characteristics associated with do-not-resuscitate/do-not-intubate orders: a cross-sectional study based on the Taiwan stroke registry

Background Previous studies of do-not-resuscitate (DNR) or do-not-intubate (DNI) orders in stroke patients have primarily been conducted in North America or Europe. However, characteristics associated with DNR/DNI orders in stroke patients in Asia have not been reported. Methods Based on the Taiwan...

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Published in:BMC palliative care 2023-09, Vol.22 (1), p.1-138, Article 138
Main Authors: Yeh, Hsu-Ling, Hsieh, Fang-I, Lien, Li-Ming, Kuo, Wen-Hua, Jeng, Jiann-Shing, Sun, Yu, Wei, Cheng-Yu, Yeh, Po-Yen, Yip, Hei-Tung, Lin, Cheng-Li, Huang, Nicole, Hsu, Kai-Cheng
Format: Article
Language:English
Subjects:
Accreditation
Advance care planning
Analysis
Cancer
Cardiopulmonary resuscitation
Care and treatment
Consent
CPR
Cross-sectional studies
Decision making
Do-not-resuscitate orders
East Asia
Heart failure
Hospice care
Hospitals
Inpatients
Intubation
Ischemia
Laws, regulations and rules
Medical records
Medical research
Medicine, Experimental
Methods
Palliative care
Patients
Physicians
Resuscitation orders
Stroke
Stroke (Disease)
Stroke patients
Terminal care
Uremia
Variables
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Summary:Background Previous studies of do-not-resuscitate (DNR) or do-not-intubate (DNI) orders in stroke patients have primarily been conducted in North America or Europe. However, characteristics associated with DNR/DNI orders in stroke patients in Asia have not been reported. Methods Based on the Taiwan Stroke Registry, this nationwide cross-sectional study enrolled hospitalized stroke patients from 64 hospitals between 2006 and 2020. We identified characteristics associated with DNR/DNI orders using a two-level random effects model. Results Among the 114,825 patients, 5531 (4.82%) had DNR/DNI orders. Patients with acute ischemic stroke (AIS) had the highest likelihood of having DNR/DNI orders (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.61-1.93), followed by patients with intracerebral hemorrhage (ICH), and patients with subarachnoid hemorrhage (SAH) had the lowest likelihood (aOR 0.53, 95% CI 0.43-0.66). From 2006 to 2020, DNR/DNI orders increased in all three types of stroke. In patients with AIS, women were significantly more likely to have DNR/DNI orders (aOR 1.23, 95% CI 1.15-1.32), while patients who received intravenous alteplase had a lower likelihood (aOR 0.74, 95% CI 0.65-0.84). Patients with AIS who were cared for by religious hospitals (aOR 0.55, 95% CI 0.35-0.87) and patients with SAH who were cared for by medical centers (aOR 0.40, 95% CI 0.17-0.96) were significantly less likely to have DNR/DNI orders. Conclusions In Taiwan, DNR/DNI orders increased in stroke patients between 2006 and 2020. Hospital characteristics were found to play a significant role in the use of DNR/DNI orders. Keywords: Resuscitation orders, Stroke, Terminal care, Inpatients, East Asia
ISSN:1472-684X
1472-684X
DOI:10.1186/s12904-023-01257-7