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Code status orders in hospitalized patients with COVID-19

BACKGROUND: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during...

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Autores principales: Comer, Amber R., Fettig, Lyle, Bartlett, Stephanie, Sinha, Shilpee, D'Cruz, Lynn, Odgers, Aubrey, Waite, Carly, Slaven, James E., White, Ryan, Schmidt, Amanda, Petras, Laura, Torke, Alexia M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470381/
https://www.ncbi.nlm.nih.gov/pubmed/37662642
http://dx.doi.org/10.1016/j.resplu.2023.100452
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author Comer, Amber R.
Fettig, Lyle
Bartlett, Stephanie
Sinha, Shilpee
D'Cruz, Lynn
Odgers, Aubrey
Waite, Carly
Slaven, James E.
White, Ryan
Schmidt, Amanda
Petras, Laura
Torke, Alexia M.
author_facet Comer, Amber R.
Fettig, Lyle
Bartlett, Stephanie
Sinha, Shilpee
D'Cruz, Lynn
Odgers, Aubrey
Waite, Carly
Slaven, James E.
White, Ryan
Schmidt, Amanda
Petras, Laura
Torke, Alexia M.
author_sort Comer, Amber R.
collection PubMed
description BACKGROUND: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. METHODS: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March–October 2020). RESULTS: Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80. CONCLUSIONS: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.
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spelling pubmed-104703812023-09-01 Code status orders in hospitalized patients with COVID-19 Comer, Amber R. Fettig, Lyle Bartlett, Stephanie Sinha, Shilpee D'Cruz, Lynn Odgers, Aubrey Waite, Carly Slaven, James E. White, Ryan Schmidt, Amanda Petras, Laura Torke, Alexia M. Resusc Plus Clinical Paper BACKGROUND: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. METHODS: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March–October 2020). RESULTS: Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80. CONCLUSIONS: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19. Elsevier 2023-08-23 /pmc/articles/PMC10470381/ /pubmed/37662642 http://dx.doi.org/10.1016/j.resplu.2023.100452 Text en © 2023 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Clinical Paper
Comer, Amber R.
Fettig, Lyle
Bartlett, Stephanie
Sinha, Shilpee
D'Cruz, Lynn
Odgers, Aubrey
Waite, Carly
Slaven, James E.
White, Ryan
Schmidt, Amanda
Petras, Laura
Torke, Alexia M.
Code status orders in hospitalized patients with COVID-19
title Code status orders in hospitalized patients with COVID-19
title_full Code status orders in hospitalized patients with COVID-19
title_fullStr Code status orders in hospitalized patients with COVID-19
title_full_unstemmed Code status orders in hospitalized patients with COVID-19
title_short Code status orders in hospitalized patients with COVID-19
title_sort code status orders in hospitalized patients with covid-19
topic Clinical Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470381/
https://www.ncbi.nlm.nih.gov/pubmed/37662642
http://dx.doi.org/10.1016/j.resplu.2023.100452
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