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. 2024 Sep 3;9(1):e001367.
doi: 10.1136/tsaco-2024-001367. eCollection 2024.

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

Diane N Haddad  1 , Nicole Meredyth  2 , Justin Hatchimonji  1 , Elizabeth Merulla  1 , Amy Matta  1 , Jason Saucier  1 , Catherine E Sharoky  1 , Gary Alan Bass  1 , Jose L Pascual  1 , Niels D Martin  1
Affiliations

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

Diane N Haddad et al. Trauma Surg Acute Care Open. .

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.

Keywords: Race; death; intensive care units; palliative care.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. Flow diagram of surgical intensive care unit (SICU) patient population, June 1, 2018 to January 31, 2023. DNR, Do Not Resuscitate.
Figure 2
Figure 2. Distribution of patient age at the time of surgical intensive care unit (SICU) admission for deceased non-trauma patients versus traumatically injured patients, June 1, 2018 to January 2023.
See this image and copyright information in PMC

References

    1. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD, Robert Wood Johnson Foundation ICU End-Of-Life Peer Group Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32:638–43. doi: 10.1097/01.ccm.0000114816.62331.08. - DOI - PubMed
    1. Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD. Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med. 2009;361:22–31. doi: 10.1056/NEJMoa0810245. - DOI - PMC - PubMed
    1. Baldor DJ, Smyrnios NA, Faris K, Guilarte-Walker Y, Celik U, Torres U. A Controlled Study in CPR-Survival in Propensity Score Matched Full-Code and Do-Not-Resuscitate ICU Patients. J Intensive Care Med. 2022;37:1363–9. doi: 10.1177/08850666221114052. - DOI - PubMed
    1. Lee RY, Brumback LC, Sathitratanacheewin S, Lober WB, Modes ME, Lynch YT, Ambrose CI, Sibley J, Vranas KC, Sullivan DR, et al. Association of Physician Orders for Life-Sustaining Treatment With ICU Admission Among Patients Hospitalized Near the End of Life. JAMA. 2020;323:950–60. doi: 10.1001/jama.2019.22523. - DOI - PMC - PubMed
    1. Beck K, Vincent A, Cam H, Becker C, Gross S, Loretz N, Müller J, Amacher SA, Bohren C, Sutter R, et al. Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A systematic review and Meta-analysis. Resuscitation. 2022;172:181–93. doi: 10.1016/j.resuscitation.2021.11.041. - DOI - PubMed

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