naa a22 4500 510799523 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9878-2 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9878-2 Is Early DNR a Self-Fulfilling Prophecy for Patients with Spontaneous Intracerebral Hemorrhage? [Elektronische Daten] [A. Jain, M. Jain, M. Bellolio, R. Schears, A. Rabinstein, L. Ganti] Background: To investigate differences in outcome of patients with intracerebral hemorrhage (ICH) based on institution of do-not-resuscitate (DNR) order within first 24h of admission. Methods: A prospective registry of patients presenting with ICH from Jan 2006 to Dec 2008 was created. Patients with and without DNR orders instituted within 24h of admission were classified as cases and controls respectively and were matched based on age and stroke severity. Demographics, intracerebral volume of hematoma, intraventricular extension of hemorrhage (IVH), invasive treatments, and outcomes at discharge were collected. All patients were followed up at least for 1year, to determine mortality outcomes. Results: Of a total of 245 subjects, 18% had DNR order instituted within 24h of admission. After matching, a total of 69 controls were available for 44 cases. There was no difference in demographics, IVH extension, volume of hemorrhage, and length of stay among cases and controls. Higher proportions of controls had surgical evacuation of the hematoma (p=0.0125) and mechanical ventilation (p=0.0001). There was no significant difference in functional outcome and survival rates among cases and controls at the end of 1week, 1month, and 1year. Conclusions: DNR institution and restriction of resuscitation was not associated with poor outcome or difference in survival within 1year after ICH. This indicates an early DNR probably does not lead to a self-fulfilling prophecy in this population, and might be explained by our practice, were DNR orders do not impact the level of supportive medical care we provide. Springer Science+Business Media New York, 2013 Cerebral hemorrhage nationallicence Do-not-resuscitate orders nationallicence Outcomes research nationallicence Jain A. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA aut Jain M. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA aut Bellolio M. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA aut Schears R. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA aut Rabinstein A. Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA aut Ganti L. Departments of Emergency Medicine and Neurological Surgery, University of Florida, Gainesville, FL, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 342-346 1541-6933 19:3<342 2013 19 12028 https://doi.org/10.1007/s12028-013-9878-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9878-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Jain A. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA aut NATIONALLICENCE 700 1- Jain M. Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA aut NATIONALLICENCE 700 1- Bellolio M. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA aut NATIONALLICENCE 700 1- Schears R. Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA aut NATIONALLICENCE 700 1- Rabinstein A. Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA aut NATIONALLICENCE 700 1- Ganti L. Departments of Emergency Medicine and Neurological Surgery, University of Florida, Gainesville, FL, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 342-346 1541-6933 19:3<342 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer