Evidence map›Paper›PMID 41142473›Full record

ArticlePalliative medicine reports2025

Hospital and Temporal Variations in Limitations of Care Among Hospitalized Patients with COVID-19: A VIRUS Registry Retrospective Cohort Study.

Nathan Mesfin, Nitesh Kumar Jain, Anwar Khedr, Hisham Mushtaq, Abbas B Jama, Noura Attallah, Esraa Hassan, Benjamin Langworthy, Nicholas Ingraham, Juan Pablo Domecq Garces and 15 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Palliative medicine reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Nathan MesfinDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.ORCID https://orcid.org/0000-0001-8419-0339
Nitesh Kumar JainDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Anwar KhedrDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Hisham MushtaqDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Abbas B JamaDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Noura AttallahDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Esraa HassanDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Benjamin LangworthyDivision of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Nicholas IngrahamDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Juan Pablo Domecq GarcesDivision of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Thoyaja KoritalaDepartment of Hospital Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Donna Lee ArmaignacCenter for Advanced Analytics, Baptist Health South Florida, Coral Gables, Florida, USA.
Nicholas Eugene PerkinsDepartment of Hospital Medicine, Prisma Health, Greenville Memorial Hospital, Grenville, South Carolina, USA.
Katherine BeldenDepartment of Medicine, Division of Infectious Disease, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
Vishakha KumarVIRUS Registry, Society of Critical Care Medicine, Mount Prospect, Illinois, USA.
Karen BomanVIRUS Registry, Society of Critical Care Medicine, Mount Prospect, Illinois, USA.
Devang K SanghaviDepartment of Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA.
Vikas BansalDepartment of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Rahul KashyapDepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Rodrigo Cartin-CebaDivision of Pulmonary Medicine, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Abigail La NouDepartment of Critical Care Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
Allan J WalkeyPulmonary Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Evans Center of Implementation and Improvement Sciences, Boston, University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
R Adams DudleyDivision of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Syed Anjum KhanDivision of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA.
Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): Covid-19 Registry Investigator Group

Funding

Identifying Areas to Improve ICU Outcomes through Provider VariationK23HL166783 · NHLBI · UNIVERSITY OF MINNESOTA · PI Nicholas E Ingraham · 2023 to 2026
$645k
NHLBI NIH HHS K23 HL166783
6 · The paper itself

Abstract

Introduction: Life-support limits (i.e., code status), the first step in the continuum of palliation and end-of-life (EoL) care, stem from decisions made by patients and their providers to align care near the EoL with patients' wishes. The pandemic created health care strain that may have influenced life-support limitation practices among patients with serious COVID-19. In this study, we examine variations in life-support limitations (do-not-resuscitate, DNR; do-not-intubate, DNI) depending on the hospital and period of hospitalization. Methods: We included all adults admitted to a hospital in the United States with COVID-19 from January 2020 to December 2021 using the VIRUS registry. Our outcome was any life-support limitation on admission (DNR, DNI, or both) using regression modeling. Main exposures were hospital and period of hospitalization (early vs. late pandemic). Covariates included age, sex, race/ethnicity, comorbidities, and hospitalization diagnoses. Results: There were 42,383 patients from 75 hospitals in the US. The median age was 63 (interquartile range: 50-75), 46.5% were female, and 37.5% were non-Hispanic White. The life-support limitation rate was 7.9%, and the palliative care consultation rate was 2.3%. The odds of life-support limitation were 1.86 (95% CI: 1.6-2.1) depending on the hospital, but the period of hospitalization was not associated with odds of life-support limitation. Older age was associated with the greatest increased odds (4.1 per standard deviation ∼ 17.9 years, 95% CI: 3.9-4.4), followed by comorbidities including paralysis (2.4, 95% CI: 1.8-3.0) and dementia (2.3, 95% CI: 2.0-2.6). Conclusions: After adjusting for patient-level factors, we report significant inter-hospital but no temporal variation in life-support limitation upon admission with COVID-19. Future studies should investigate specific practices that led to health care resilience to temporal practice variations in life-support limitation during the pandemic.

Indexed as

code statusCOVID-19do-not-resuscitatelife support carewithholding treatment

Identifiers

PMID41142473
PMCPMC12547400

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.