Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland

• Published in: World journal of emergency medicine Vol. 11; no. 4; pp. 231 - 237
• Main Authors: Ding, Chuan-qi, Zhang, Yu-ping, Wang, Yu-wei, Yang, Min-fei, Wang, Sa, Cui, Nian-qi, Jin, Jing-fen
• Format: Journal Article
• Language: English
• Published: China World Journal of Emergency Medicine 2020; Department of Nursing,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,China%Department of Emergency Medicine,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,China; Second Affiliated Hospital of Zhejiang University School of Medicine
• Subjects: Analysis; Cardiology; Decision making; Do-not-resuscitate orders; Hospital emergency services; Medical research; Original; China; Retrospective analysis; Emergency service; Emergency departments; Death patients; Do-not-resuscitate
• ISSN: 1920-8642
• DOI: 10.5847/wjem.j.1920-8642.2020.04.005

BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients' deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients' deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors influenced the family surrogates' decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confidence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) >72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation. KEYWORDS: Emergency service; Do-not-resuscitate; Death patients; Retrospective analysis; Emergency departments