ArticleCritical care medicine2014
Do-not-resuscitate status and observational comparative effectiveness research in patients with septic shock*.
Article in Critical care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
22 citing papers in PubMed, 44 citations in OpenAlex.
- Observational
- Racial disparities in end-of-life suffering within surgical intensive care units.Trauma surgery & acute care open · 2024Article
- Validity of ICD codes to identify do-not-resuscitate orders among older adults with heart failure: A single center study.PloS one · 2023Article
- Overlooked Shortcomings of Observational Studies of Interventions in Coronavirus Disease 2019: An Illustrated Review for the Clinician.Open forum infectious diseases · 2021Review
- Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study.Resuscitation · 2021Observational
- Performance of Critical Care Outcome Prediction Models in an Intermediate Care Unit.Journal of intensive care medicine · 2020Article
- Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study.BMC pulmonary medicine · 2020Article
- Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland.World journal of emergency medicine · 2020Article
- Hospital Mechanical Ventilation Volume and Patient Outcomes: Too Much of a Good Thing?Critical care medicine · 2019Article
- Association Between the Communication Skills of Physicians and the Signing of Do-Not-Resuscitate Consent for Terminally Ill Patients in Emergency Rooms (Cross-Sectional Study).Risk management and healthcare policy · 2019Article
- Hospital mortality prediction for intermediate care patients: Assessing the generalizability of the Intermediate Care Unit Severity Score (IMCUSS).Journal of critical care · 2018Article
- Hospital Variation in Utilization of Life-Sustaining Treatments among Patients with Do Not Resuscitate Orders.Health services research · 2018Article
- Accounting for Patient Preferences Regarding Life-Sustaining Treatment in Evaluations of Medical Effectiveness and Quality.American journal of respiratory and critical care medicine · 2017Article
- Variation in Do-Not-Resuscitate Orders and Implications for Heart Failure Risk-Adjusted Hospital Mortality Metrics.JACC. Heart failure · 2017Article
- Association between Do Not Resuscitate/Do Not Intubate Status and Resident Physician Decision-making. A National Survey.Annals of the American Thoracic Society · 2017Article
- Association of Early Do-Not-Resuscitate Orders with Unplanned Readmissions among Patients Hospitalized for Pneumonia.Annals of the American Thoracic Society · 2017Article
- Impact of early do-not-attempt-resuscitation orders on procedures and outcomes of severe sepsis.Journal of critical care · 2016Article
- Improved Outcomes in Critically Ill Patients With AIDS: How Does This Trend Continue?Critical care medicine · 2016Article
- High Mortality in Severe Sepsis and Septic Shock Patients with Do-Not-Resuscitate Orders in East Asia.PloS one · 2016Article
- Association of Do-Not-Resuscitate Orders and Hospital Mortality Rate Among Patients With Pneumonia.JAMA internal medicine · 2016Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
Abstract
objectivesTo assess the importance of including do-not-resuscitate status in critical care observational comparative effectiveness research.
designRetrospective analysis.
settingAll California hospitals participating in the 2007 California State Inpatient Database, which provides do-not-resuscitate status within the first 24 hours of admission. PATIENTS: Septic shock present at admission.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe investigated the association of early do-not-resuscitate status with in-hospital mortality among patients with septic shock. We also examined the strength of confounding of do-not-resuscitate status on the association between activated protein C therapy and mortality, an association with conflicting results between observational and randomized studies. We identified 24,408 patients with septic shock; 19.6% had a do-not-resuscitate order. Compared with patients without a do-not-resuscitate order, those with a do-not-resuscitate order were significantly more likely to be older (75 ± 14 vs 67 ± 16 yr) and white (62% vs 53%), with more acute organ failures (1.44 ± 1.15 vs 1.38 ± 1.15), but fewer inpatient interventions (1.0 ± 1.0 vs 1.4 ± 1.1). Adding do-not-resuscitate status to a model with 47 covariates improved mortality discrimination (c-statistic, 0.73-0.76; p < 0.001). Addition of do-not-resuscitate status to a multivariable model assessing the association between activated protein C and mortality resulted in a 9% shift in the activated protein C effect estimate toward the null (odds ratio from 0.78 [95% CI, 0.62-0.99], p = 0.04, to 0.85 [0.67-1.08], p = 0.18).
conclusionsAmong patients with septic shock, do-not-resuscitate status acts as a strong confounder that may inform past discrepancies between observational and randomized studies of activated protein C. Inclusion of early do-not-resuscitate status into more administrative databases may improve observational comparative effectiveness methodology.
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