ArticleScandinavian journal of trauma, resuscitation and emergency medicine2015
The epidemiology of do-not-resuscitate orders in patients with trauma: a community level one trauma center observational experience.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.
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10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Sex-related differences in end-of-life decision-making in patients with traumatic brain injury: a systematic review and meta-analysis.BMC palliative care · 2026Pooled it
- Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Part 3: Trauma Ethics and Systems Aspects.World journal of surgery · 2025Guideline
- Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature.Journal of hospital medicine · 2019Pooled it
- Goals of care discussions and treatment limitation decisions in European acute geriatric units: a one-day cross-sectional study.Age and ageing · 2025Article
- Reality of treatment for severely injured patients: are there age-specific differences?BMC emergency medicine · 2024Article
- Review
- Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury.Journal of pain and symptom management · 2019Article
- Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample.Journal of community hospital internal medicine perspectives · 2018Article
- Do-Not-Resuscitate status as an independent risk factor for patients undergoing surgery for hip fracture.World journal of orthopedics · 2017Article
- End of Life Care and Do Not Resuscitate Orders: How Much Does Age Influence Decision Making? A Systematic Review and Meta-Analysis.Gerontology & geriatric medicineReview
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7 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDo-Not-Resuscitate (DNR) orders in patients with traumatic injury are insufficiently described. The objective is to describe the epidemiology and outcomes of DNR orders in trauma patients.
methodsWe included all adults with trauma to a community Level I Trauma Center over 6 years (2008-2013). We used chi-square, Wilcoxon rank-sum, and multivariate stepwise logistic regression tests to characterize DNR (established in-house vs. pre-existing), describe predictors of establishing an in-house DNR, timing of an in-house DNR (early [within 1 day] vs late), and outcomes (death, ICU stay, major complications).
resultsIncluded were 10,053 patients with trauma, of which 1523 had a DNR order in place (15%); 715 (7%) had a pre-existing DNR and 808 (8%) had a DNR established in-house. Increases were observed over time in both the proportions of patients with DNRs established in-house (p = 0.008) and age ≥65 (p < 0.001). Over 90% of patients with an in-house DNR were ≥65 years. The following covariates were independently associated with establishing a DNR in-house: age ≥65, severe neurologic deficit (GCS 3-8), fall mechanism of injury, ED tachycardia, female gender, and comorbidities (p < 0.05 for all). Age ≥65, female gender, non-surgical service admission and transfers-in were associated with a DNR established early (p < 0.05 for all). As expected, mortality was greater in patients with DNR than those without (22% vs. 1%), as was the development of a major complication (8% vs. 5%), while ICU admission was similar (19% vs. 17%). Poor outcomes were greatest in patients with DNR orders executed later in the hospital stay.
conclusionsOur analysis of a broad cohort of patients with traumatic injury establishes the relationship between DNR and patient characteristics and outcomes. At 15%, DNR orders are prevalent in our general trauma population, particularly in patients ≥65 years, and are placed early after arrival. Established prognostic factors, including age and physiologic severity, were determinants for in-house DNR orders. These data may improve physician predictions of outcomes with DNR and help inform patient preferences, particularly in an environment with increasing use of DNR and increasing age of patients with trauma.
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