Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Dec;29(3):419-425.
doi: 10.1007/s12028-018-0554-4.

Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage

Cora H Ormseth  1 , Guido J Falcone  1 , Sara D Jasak  1 , David M Mampre  1 , Audrey C Leasure  1 , Laura C Miyares  1 , David Y Hwang  1 , Michael L James  2 , Fernando D Testai  3 , Kyra J Becker  4 , David L Tirschwell  4 , Carl D Langefeld  5 , Daniel Woo  6 , Kevin N Sheth  7
Affiliations
Observational Study

Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage

Cora H Ormseth et al. Neurocrit Care. 2018 Dec.

Abstract

Background: Prior studies of patients in the intensive care unit have suggested racial/ethnic variation in end-of-life decision making. We sought to evaluate whether race/ethnicity modifies the implementation of comfort measures only status (CMOs) in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH).

Methods: We analyzed data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a prospective cohort study specifically designed to enroll equal numbers of white, black, and Hispanic subjects. ICH patients aged ≥ 18 years were enrolled in ERICH at 42 hospitals in the USA from 2010 to 2015. Univariate and multivariate logistic regression analyses were implemented to evaluate the association between race/ethnicity and CMOs after adjustment for potential confounders.

Results: A total of 2705 ICH cases (912 black, 893 Hispanic, 900 white) were included in this study (mean age 62 [SD 14], female sex 1119 [41%]). CMOs patients comprised 276 (10%) of the entire cohort; of these, 64 (7%) were black, 79 (9%) Hispanic, and 133 (15%) white (univariate p < 0.001). In multivariate analysis, compared to whites, blacks were half as likely to be made CMOs (OR 0.50, 95% CI 0.34-0.75; p = 0.001), and no statistically significant difference was observed for Hispanics. All three racial/ethnic groups had similar mortality rates at discharge (whites 12%, blacks 9%, and Hispanics 10%; p = 0.108). Other factors independently associated with CMOs included age (p < 0.001), premorbid modified Rankin Scale (p < 0.001), dementia (p = 0.008), admission Glasgow Coma Scale (p = 0.009), hematoma volume (p < 0.001), intraventricular hematoma volume (p < 0.001), lobar (p = 0.032) and brainstem (p < 0.001) location and endotracheal intubation (p < 0.001).

Conclusions: In ICH, black patients are less likely than white patients to have CMOs. However, in-hospital mortality is similar across all racial/ethnic groups. Further investigation is warranted to better understand the causes and implications of racial disparities in CMO decisions.

Keywords: End-of-life care; Intracerebral hemorrhage; Race and ethnicity.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: All authors report no competing interests relevant to the manuscript.

Figures

Figure 1
Figure 1. Survival to discharge by race/ethnicity
Despite different rates of implementation of CMOs, survival distributions at discharge did not differ by race/ethnicity (p=0.097).
See this image and copyright information in PMC

References

    1. Becker KJ, Baxter AB, Cohen WA, et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56:766–72. - PubMed
    1. Hwang DY, Dell CA, Sparks MJ, et al. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology. 2016;86:126–33. - PMC - PubMed
    1. Cai X, Robinson J, Muehlschlegel S, et al. Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units. Neurocritical Care. 2015;23:131–41. - PMC - PubMed
    1. Holloway RG, Benesch CG, Burgin WS, Zentner JB. Prognosis and decision making in severe stroke. JAMA. 2005;294:725–33. - PubMed
    1. Cooper Z, Rivara FP, Wang J, MacKenzie EJ, Jurkovich GJ. Racial disparities in intensity of care at the end-of-life: are trauma patients the same as the rest? Journal of Health Care for the Poor and Underserved. 2012;23:857–74. - PubMed

Publication types

LinkOut - more resources