Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study
<b>Background:</b> “Do Not Resuscitate” (DNR) status has been implicated as an independent risk factor for mortality in patients admitted to the ICU. The implications of DNR status in older, critically ill patients for whom these conversations are often most relevant are less known. <...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-03-01
|
| Series: | Emergency Care and Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2813-7914/2/2/16 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850156956417785856 |
|---|---|
| author | Jessica T. Kent Rishi Ghosh |
| author_facet | Jessica T. Kent Rishi Ghosh |
| author_sort | Jessica T. Kent |
| collection | DOAJ |
| description | <b>Background:</b> “Do Not Resuscitate” (DNR) status has been implicated as an independent risk factor for mortality in patients admitted to the ICU. The implications of DNR status in older, critically ill patients for whom these conversations are often most relevant are less known. <b>Objective:</b> To determine the relationship between code status and mortality in a subset of critically ill, older ICU patients. <b>Methods:</b> Retrospective cohort study of critically ill older adults as defined by an APACHE II score ≥20 and age ≥70, admitted to the ICU at a large community hospital in Ontario from 1 January 2013 to 31 December 2018. <b>Results:</b> Of 613 patients admitted to the ICU, 163 met the inclusion criteria. Of these, 64 (39.3%) had a DNR order, while the remaining 99 (60.7%) did not and were considered full code. We found a strong association between DNR status and mortality (OR 2.61; 95% CI 1.33 to 5.09). Patients with a DNR order stayed fewer days in the ICU (7.7 days (±3.6) vs. 9.9 days (±8.3)) and used fewer resources than similarly ill patients who were full code with no difference in discharge morbidity. Patients with a DNR order had lower average costs of hospital and ICU admissions in comparison to patients who were full code (CAD 49,589.10/pt. vs. CAD 59,704.70/pt. (Canadian dollars)). <b>Conclusions:</b> Among critically ill, older ICU patients, DNR status is strongly associated with in-hospital mortality. Those in the full code group used more resources, resulting in higher costs of hospitalization without any difference in discharge morbidity. |
| format | Article |
| id | doaj-art-39976d2d08cf4af098fa22a282962c74 |
| institution | OA Journals |
| issn | 2813-7914 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Emergency Care and Medicine |
| spelling | doaj-art-39976d2d08cf4af098fa22a282962c742025-08-20T02:24:21ZengMDPI AGEmergency Care and Medicine2813-79142025-03-01221610.3390/ecm2020016Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort StudyJessica T. Kent0Rishi Ghosh1Department of Emergency Medicine, St. Michael’s Hospital, Toronto, ON M5B 1W8, CanadaDepartment of Medicine, NOSM University, Sault Ste. Marie, Ontario, ON P3E 2C6, Canada<b>Background:</b> “Do Not Resuscitate” (DNR) status has been implicated as an independent risk factor for mortality in patients admitted to the ICU. The implications of DNR status in older, critically ill patients for whom these conversations are often most relevant are less known. <b>Objective:</b> To determine the relationship between code status and mortality in a subset of critically ill, older ICU patients. <b>Methods:</b> Retrospective cohort study of critically ill older adults as defined by an APACHE II score ≥20 and age ≥70, admitted to the ICU at a large community hospital in Ontario from 1 January 2013 to 31 December 2018. <b>Results:</b> Of 613 patients admitted to the ICU, 163 met the inclusion criteria. Of these, 64 (39.3%) had a DNR order, while the remaining 99 (60.7%) did not and were considered full code. We found a strong association between DNR status and mortality (OR 2.61; 95% CI 1.33 to 5.09). Patients with a DNR order stayed fewer days in the ICU (7.7 days (±3.6) vs. 9.9 days (±8.3)) and used fewer resources than similarly ill patients who were full code with no difference in discharge morbidity. Patients with a DNR order had lower average costs of hospital and ICU admissions in comparison to patients who were full code (CAD 49,589.10/pt. vs. CAD 59,704.70/pt. (Canadian dollars)). <b>Conclusions:</b> Among critically ill, older ICU patients, DNR status is strongly associated with in-hospital mortality. Those in the full code group used more resources, resulting in higher costs of hospitalization without any difference in discharge morbidity.https://www.mdpi.com/2813-7914/2/2/16DNRcode statuscritical caremortalityresource utilization |
| spellingShingle | Jessica T. Kent Rishi Ghosh Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study Emergency Care and Medicine DNR code status critical care mortality resource utilization |
| title | Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study |
| title_full | Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study |
| title_fullStr | Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study |
| title_full_unstemmed | Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study |
| title_short | Quantifying the Association Between Code Status Discussions and Outcomes in Critically Ill Older Adults Admitted to the Intensive Care Unit (ICU): A Retrospective Cohort Study |
| title_sort | quantifying the association between code status discussions and outcomes in critically ill older adults admitted to the intensive care unit icu a retrospective cohort study |
| topic | DNR code status critical care mortality resource utilization |
| url | https://www.mdpi.com/2813-7914/2/2/16 |
| work_keys_str_mv | AT jessicatkent quantifyingtheassociationbetweencodestatusdiscussionsandoutcomesincriticallyillolderadultsadmittedtotheintensivecareuniticuaretrospectivecohortstudy AT rishighosh quantifyingtheassociationbetweencodestatusdiscussionsandoutcomesincriticallyillolderadultsadmittedtotheintensivecareuniticuaretrospectivecohortstudy |