Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study
Open accessAbstract
Aim:Our aim was to examine how code status orders for patients hospitalized with COVID-19 changed over time as the pandemic progressed and outcomes improved. Methods:This retrospective cohort study was performed at a single academic center in the United States. Adults admitted between March 1, 2020, and December 31, 2021, who tested positive for COVID-19, were included. The study period included four institutional hospitalization surges. Demographic and outcome data were collected and code status orders during admission were trended. Data were analyzed with multivariable analysis to identify predictors of code status. Results:A total of 3615 patients were included with full code (62.7%) being the most common final code status order followed by do-not-attempt-resuscitation (DNAR) (18.1%). Time of admission (per every six months) was an independent predictor of final full compared to DNAR/partial code status (p = 0.04). Limited resuscitation preference (DNAR or partial) decreased from over 20% in the first two surges to 10.8% and 15.6% of patients in the last two surges. Other independent predictors of final code status included body mass index (p < 0.05), Black versus White race (0.64, p = 0.01), time spent in the intensive care unit (4.28, p = <0.001), age (2.11, p = <0.001), and Charlson comorbidity index (1.05, p = <0.001). Conclusions:Over time, adults admitted to the hospital with COVID-19 were less likely to have a DNAR or partial code status order with persistent decrease occurring after March 2021. A trend toward decreased code status documentation as the pandemic progressed was observed.
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The present result agrees with another study that found declining selection of limited resuscitation options over the pandemic.
“This finding is in line with another study that also saw fewer people choosing limited resuscitation options as the pandemic went on.5”
From In-Hospital Code Status Updates: Trends Over Time and the Impact of COVID-19 (2024) · cites this paper as [5]
The data indicate that the pandemic setting contributed to how patients made code status decisions.
“Although our study did not directly investigate these hypotheses, the data suggests that the pandemic context played a role in shaping patient choices.5”
From In-Hospital Code Status Updates: Trends Over Time and the Impact of COVID-19 (2024) · cites this paper as [5]
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- Authors
- Jacobson, E., Troost, J. P., Epler, K., Lenhan, B., Rodgers, L., O'Callaghan, T., Painter, N., & Barrett, J.
- Affiliations
- University of Michigan (US)
- University of California San Diego (US)
- University of Utah (US)
- University of Washington (US)
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
- Corresponding author
- Jacobson, Emily
- Venue
- Journal of Palliative Medicine
- Publisher
- SAGE Publications
- Published
- 2023-09-01
- Volume
- 26
- Issue
- 9
- Pages
- 1188-1197
- ISSN
- 1096-6218 (ISSN-L)
- 1557-7740
- PMC
- PMC10623069
- OpenAlex
- W4362656995
- Cited by
- 4
- References
- 38
- Citations by year
- 2025: 2 · 2023: 2
- FWCI
- 1.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Palliative Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR002240, UM1TR004404)
- Michigan Institute for Clinical and Health Research (UL1 TR002240)
- National Center for Advancing Translational Sciences
- Topics
- 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
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, do not attempt resuscitation, advance care planning, temporal trends, ICU length of stay, comorbidities, racial disparities, body mass index, end-of-life preferences
- MeSH terms
- COVID-19, Adult, Hospitalization, Humans, Retrospective Studies, United States, Resuscitation Orders, Pandemics
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