November 1, 2013

Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage

Kazuma Nakagawa, MD; Megan A. Vento, BS; Todd B. Seto, MD, MPH; Matthew A. Koenig, MD; Susan M. Asai, MSN; Cherylee W. Chang, MD; and J. Claude Hemphill, MD, MAS


Background and Purpose—Studies show that women are more likely to receive do-notresuscitate (DNR) orders after acute medical illnesses than men. However, the sex differences in the use of DNR orders after acute intracerebral hemorrhage (ICH) has not been described.

Methods—We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were performed to test for associations between female sex and early  (<24 hours of presentation) DNR orders.

Results—A total of 372 consecutive ICH patients without pre-existing DNR orders were studied. Overall, 82 (22%) patients had early DNR orders after being hospitalized with ICH. In the fully adjusted model, early DNR orders were more likely in women (odds ratio 3.18, 95% CI 1.51 to 6.70), higher age (odds ratio 1.09 per year, 95% CI 1.05 to 1.12), larger ICH volume (odds ratio 1.01 per cm3, 95% CI 1.01 to 1.02), and lower initial GCS score (odds ratio 0.76 per point, 95% CI 0.69 to 0.84). Early DNR orders were less likely when the patients were transferred from another hospital (odds ratio 0.28, 95% 0.11 to 0.76).

Conclusions—Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.

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