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Racial disparities in end-of-life suffering within surgical intensive care units. | LitMetric

AI Article Synopsis

  • The study investigates end-of-life (EOL) care in a surgical intensive care unit (SICU) setting, focusing on how provider assessments of futility influence the rate of Do Not Resuscitate (DNR) decisions among patients.
  • A retrospective analysis of a SICU registry from 2018-2022 revealed that only a quarter of deceased patients had expected deaths, with notable differences in DNR status based on injury type and race.
  • The findings indicate that Black patients were less likely to have DNR status at death, emphasizing the need for improved discussions around EOL care to prevent unnecessary interventions and suffering.

Article Abstract

Background: End-of-life (EOL) care is associated with high resource utilization. Recognizing and effectively communicating that EOL is near promotes more patient-centered care, while decreasing futile interventions. We hypothesize that provider assessment of futility during the surgical intensive care unit (SICU) admission would result in higher rates of Do Not Resuscitate (DNR).

Methods: We performed a retrospective review of a prospective SICU registry of all deceased patients across a health system, 2018-2022. The registry included a subjective provider assessment of patient's expected survival. We employed multivariable logistic regression to adjust for clinical factors while assessing for association between code status at death and provider's survival assessment with attention to race-based differences.

Results: 746 patients-105 (14.1%) traumatically injured and 641 (85.9%) non-traumatically injured-died over 4.5 years in the SICU (mortality rate 5.9%). 26.3% of these deaths were expected by the ICU provider. 40.9% of trauma patients were full code at the time of death, compared with 15.6% of non-traumatically injured patients. Expected death was associated with increased odds of DNR code status for non-traumatically injured patients (OR 1.8, 95% CI 1.03 to 3.18), but not for traumatically injured patients (OR 0.82, 95% CI 0.22 to 3.08). After adjusting for demographic and clinical characteristics, black patients were less likely to be DNR at the time of death (OR 0.49, 95% CI 0.32 to 0.75).

Conclusion: 20% of patients who died in our SICU had not declared a DNR status, with injured black patients more likely to remain full code at the time of death. Further evaluation of this cohort to optimize recognition and communication of EOL is needed to avoid unnecessary suffering.

Level Of Evidence: Level III/prognostic and epidemiological.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409343PMC
http://dx.doi.org/10.1136/tsaco-2024-001367DOI Listing

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