The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.
Severe Sepsis in Do-not-resuscitate Patients: Intervention and Mortality Rates
Abstract
Background Severe sepsis is a high-mortality disease, and early resuscitation decreases mortality. Do-not-resuscitate (DNR) status may influence physician decisions beyond cardiopulmonary resuscitation, but this has not been investigated in sepsis. Objective Among Emergency Department (ED) severe sepsis patients, define the incidence of DNR status, prevalence of central venous catheter placement, and vasopressor administration (invasive measures), and mortality. Methods Retrospective observational cohort of consecutive severe sepsis patients to single ED in 2009-2010. Charts abstracted for DNR status on presentation, demographics, vitals, Sequential Organ Failure Assessment (SOFA) score, inpatient and 60-day mortality, and discharge disposition. Primary outcomes were mortality, discharge to skilled nursing facility (SNF), and invasive measure compliance. Chi-squared test was used for univariate association of DNR status and outcome variables; multivariate logistic regression analyses for outcome variables controlling for age, gender, SOFA score, and DNR status. Results In 376 severe sepsis patients, 50 (13.3%) had DNR status. DNR patients were older (79.2 vs 60.3 years, p < 0.001) and trended toward higher SOFA scores (7 vs. 6, p = 0.07). DNR inpatient and 60-day mortalities were higher (50.5% vs. 19.6%, 95% confidence interval [CI] 15.9-44.9%; 64.0% vs. 24.9%, 95% CI 25.1-53.3%, respectively), and remained higher in multivariate logistic regression analysis (odds ratio [OR] 3.01, 95% CI 1.48-6.17; OR 3.80, 95% CI 1.88-7.69, respectively). The groups had similar rates of discharge to SNF, and in persistently hypotensive patients (n = 326) had similar rates of invasive measures in univariate and multivariate analyses (OR 1.19, 95% CI 0.45-3.15). Conclusion In this sample, 13.3% of severe sepsis patients had DNR status, and 50% of DNR patients survived to hospital discharge. DNR patients received invasive measures at a rate similar to patients without DNR status.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The findings suggest a higher rate of DNACPR use (31%) than identified in previous studies of other respiratory conditions or sepsis.
“Our findings suggest a higher rate of DNACPR use (31%) than identified in previous studies of other respiratory conditions or sepsis.”
Studies in severe sepsis or septic shock reported rates of DNACPR use ranging from 9% to 20%.
“while studies in severe sepsis or septic shock reported rates ranging from 9% to 20%.11, 12, 13, 14”
Previous studies have estimated the prevalence of DNACPR decision in patients admitted to hospital with community-acquired pneumonia and sepsis, and have attempted to identify factors associated with DNACPR use, but we currently know very little about how DNACPR decisions have been used in people admitted with suspected COVID-19.
“Previous studies have estimated the prevalence of DNACPR decision in patients admitted to hospital with community-acquired pneumonia6, 7, 8, 9, 10 and sepsis,11, 12, 13, 14 and have attempted to identify factors associated with DNACPR use, but we currently know very little about how DNACPR decisions have been used in people admitted with suspected COVID-19.”
Citations
Cites
Puskarich, M. A., Trzeciak, S., Shapiro, N. I., Arnold, R. C., Horton, J. M., Studnek, J. R., Kline, J. A., & Jones, A. E. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e31821e87ab · Cited by 376
Flagged first, then by citations
Research works printed but not linked: 25
- Brun-Buisson, 2000, The epidemiology of the systemic inflammatory response, Intensive Care Med, 26, S64
- Angus, 2001, Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care, Crit Care Med, 29, 1303, 10.1097/00003246-200107000-00002 · DOI · Paper page
- Martin, 2003, The epidemiology of sepsis in the United States from 1979 through 2000, N Engl J Med, 348, 1546, 10.1056/NEJMoa022139 · DOI · Paper page
- Castellanos-Ortega, 2010, Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study, Crit Care Med, 38, 1036, 10.1097/CCM.0b013e3181d455b6 · DOI
- Dellinger, 2005, The Surviving Sepsis Campaign sepsis change bundles and clinical practice, Crit Care, 9, 653, 10.1186/cc3952 · DOI
- Gao, 2005, The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study, Crit Care, 9, R764, 10.1186/cc3909 · DOI · Paper page
- Micek, 2006, Before-after study of a standardized hospital order set for the management of septic shock, Crit Care Med, 34, 2707, 10.1097/01.CCM.0000241151.25426.D7 · DOI
- Nguyen, 2007, Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality, Crit Care Med, 35, 1105, 10.1097/01.CCM.0000259463.33848.3D · DOI · Paper page
- Rivers, 2001, Early goal-directed therapy in the treatment of severe sepsis and septic shock, N Engl J Med, 345, 1368, 10.1056/NEJMoa010307 · DOI · Paper page
- Ishihara, 1996, Advance directives in the emergency department: too few, too late, Acad Emerg Med, 3, 50, 10.1111/j.1553-2712.1996.tb03303.x · DOI
- Lahn, 2001, Advance directives in skilled nursing facility residents transferred to emergency departments, Acad Emerg Med, 8, 1158, 10.1111/j.1553-2712.2001.tb01133.x · DOI
- Llovera, 1997, Are emergency department patients thinking about advance directives?, Acad Emerg Med, 4, 976, 10.1111/j.1553-2712.1997.tb03663.x · DOI
- Wrenn, 1992, Do-not-resuscitate orders in the emergency department, Am J Med, 92, 129, 10.1016/0002-9343(92)90102-H · DOI
- Bedell, 1986, Do-not-resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact?, JAMA, 256, 233, 10.1001/jama.1986.03380020095030 · DOI
- Evans, 1985, The do-not-resuscitate order in teaching hospitals, JAMA, 253, 2236, 10.1001/jama.1985.03350390078029 · DOI
- Holtzman, 1994, Changes in orders limiting care and the use of less aggressive care in a nursing home population, J Am Geriatr Soc, 42, 275, 10.1111/j.1532-5415.1994.tb01751.x · DOI
- La Puma, 1988, Life-sustaining treatment. A prospective study of patients with DNR orders in a teaching hospital, Arch Intern Med, 148, 2193, 10.1001/archinte.1988.00380100067015 · DOI
- Lipton, 1986, Do-not-resuscitate decisions in a community hospital. Incidence, implications, and outcomes, JAMA, 256, 1164, 10.1001/jama.1986.03380090104026 · DOI
- Uhlmann, 1984, Some treatment-withholding implications of no-code orders in an academic hospital, Crit Care Med, 12, 879, 10.1097/00003246-198410000-00009 · DOI
- Cohen, 2009, The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit, J Crit Care, 24, 311, 10.1016/j.jcrc.2008.01.007 · DOI
- Moreno, 2008, Sepsis mortality prediction based on predisposition, infection and response, Intensive Care Med, 34, 496, 10.1007/s00134-007-0943-1 · DOI
- Dellinger, 2008, Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008, Intensive Care Med, 34, 17, 10.1007/s00134-007-0934-2 · DOI
- Jones, 2009, The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation, Crit Care Med, 37, 1649, 10.1097/CCM.0b013e31819def97 · DOI
- Fuchs, 2012, ICU admission characteristics and mortality rates among elderly and very elderly patients, Intensive Care Med, 38, 1654, 10.1007/s00134-012-2629-6 · DOI
- Sprung, 2008, Hydrocortisone therapy for patients with septic shock, N Engl J Med, 358, 111, 10.1056/NEJMoa071366 · DOI
Cited by
Sorted by citations
Sutton, L., Goodacre, S., Thomas, B., & Connelly, S. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.04.028 · Cited by 27
Huang, C.-T., Chuang, Y.-C., Tsai, Y.-J., Ko, W.-J., & Yu, C.-J. (2016) · PLOS ONE · doi:10.1371/journal.pone.0159501 · Cited by 27
Metadata
- Authors
- Powell, E. S., Sauser, K., Cheema, N., Pirotte, M. J., Quattromani, E., Avula, U., Khare, R. K., & Courtney, D. M.
- Affiliations
- Northwestern University (US)
- Venue
- The Journal of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 44
- Issue
- 4
- Pages
- 742-749
- ISSN
- 0736-4679 (ISSN-L)
- OpenAlex
- W2119035201
- Cited by
- 17
- References
- 1
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 2 · 2021: 1 · 2020: 1 · 2017: 3 · 2016: 3 · 2015: 2 · 2014: 2
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (K08HS019005-01, F-32 HS 020766-01, T32HS000078)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- severe sepsis, do-not-resuscitate orders, sepsis mortality, central venous catheters, vasopressors, invasive procedures, hypotension, skilled nursing facility discharge, emergency department patients, end-of-life decisions, SOFA score, discharge disposition, physician decision-making, advance directives, resuscitation decisions, quality of life, quality of care
- MeSH terms
- Aged, Catheterization, Central Venous, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Retrospective Studies, Vasoconstrictor Agents, Multivariate Analysis, Resuscitation Orders, Sepsis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
