An American study suggests people hospitalized with a life-threatening stroke are more likely to die if an early decision is made not to revive them. One of the researchers says the results imply that do-not-resuscitate (DNR) orders should be delayed until it is clear whether the patient’s outlook is improving.
Doctors may enter DNR orders into a patient’s medical chart after consultation with the family. They can also be specified in an advance health-care directive, or living will. The DNR order means that doctors will not attempt resuscitation if the patient stops breathing or their heart stops beating. In many cases these attempts will be futile, or the person will be left with permanent disabilities.
But researchers at the University of Michigan in Ann Arbor found that people with a stroke caused by bleeding in the brain were twice as likely to die if they had received a DNR order within 24 hours of arrival at hospital, compared with those who had not. This added mortality risk remained even after accounting for the patient’s age and the seriousness of the bleeding.
Dr. Darin Zahuranec, the lead study author, says the study results should be interpreted carefully. “It’s overstating to say doctors are giving up too early.” But he adds there is some suggestion that hospitals may provide less aggressive care when there is a DNR order in place. In fact, recent guidelines from the American Stroke Association suggest waiting 24 hours before considering such an order. “It’s going to make me a little more cautious early on,” Zahuranec says of the study.
The research was based on 270 spontaneous cases of bleeding in the brain that were treated at seven hospitals in Texas between 2000 and 2003. Thirty-four per cent of patients received a DNR order within 24 hours of hospital arrival. The researchers tracked death rates after 30 days and through the end of 2005. In all, 43 per cent of patients had died by the end of the first month, and 55 percent had died by the end of the study period.