Do-not-resuscitate orders in acute stroke

Andrei Alexandrov, Christopher F. Bladin, Eric M. Meslin, John W. Norris

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Although the general guidelines for do-not-resuscitate (DNR) orders apply to acute stroke patients, few data are available to aid decision-making. With a view to developing specific guidelines for use in patients with acute stroke, we decided to evaluate the clinical factors associated with DNR orders at our university teaching hospital. We prospectively studied 450 consecutive patients with acute hemispheric strokes (237 men and 213 women, mean age 75 ±12 years). Thirty-six patients (8%) had intracerebral hemorrhage (ICH) and 414 (92%) had ischemic strokes. Overall inhospital mortality was 26%. DNR status was given to 31% of all patients at some time during their admission (83% of those died). DNR decision-making was closely associated with the severity of the neurologic deficit (Canadian Neurological Scale score ≤5); the patient's incapacity for informed DNR decision-making; age (>60 years); and devastating ICH unsuitable for surgery (p < 0.001). Fifty-three percent of DNR orders were given on admission (first 24 hours of the hospital stay), 35% during the first week of the hospital stay, due to brain damage, and 12% at any time between days 8 and 44 due to systemic complications. Once DNR status was given, 53% of patients continued to receive normal nutrition and 60% still received medical or surgical treatment. Although the current practice of DNR orders in patients with acute stroke is generally satisfactory, some criteria (eg, age and operable ICH) need revision. Following the decision to withhold CPR, patients with severe stroke, irreversible brain damage, and/or significant comorbidities should receive DNR status whenever the prognosis has become clear for physicians and family. We suggest provisional disease-specific criteria for DNR decision-making in acute stroke.

Original languageEnglish (US)
Pages (from-to)634-640
Number of pages7
JournalNeurology
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1995

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Resuscitation Orders
Stroke
Decision Making
Cerebral Hemorrhage
Length of Stay
Guidelines
Cardiopulmonary Resuscitation
Family Physicians
Brain
Neurologic Manifestations
Hospital Mortality
Teaching Hospitals
Comorbidity

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Alexandrov, A., Bladin, C. F., Meslin, E. M., & Norris, J. W. (1995). Do-not-resuscitate orders in acute stroke. Neurology, 45(4), 634-640. https://doi.org/10.1212/WNL.45.4.634

Do-not-resuscitate orders in acute stroke. / Alexandrov, Andrei; Bladin, Christopher F.; Meslin, Eric M.; Norris, John W.

In: Neurology, Vol. 45, No. 4, 01.01.1995, p. 634-640.

Research output: Contribution to journalArticle

Alexandrov, A, Bladin, CF, Meslin, EM & Norris, JW 1995, 'Do-not-resuscitate orders in acute stroke', Neurology, vol. 45, no. 4, pp. 634-640. https://doi.org/10.1212/WNL.45.4.634
Alexandrov, Andrei ; Bladin, Christopher F. ; Meslin, Eric M. ; Norris, John W. / Do-not-resuscitate orders in acute stroke. In: Neurology. 1995 ; Vol. 45, No. 4. pp. 634-640.
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