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Stroke. 2013 Nov;44(11):3229-31. doi: 10.1161/STROKEAHA.113.002814. Epub 2013 Aug 27.

Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage.

Author information

1
From The Queen's Medical Center, Honolulu, HI (K.N., M.A.V., T.B.S., M.A.K., S.M.A., C.W.J.C.); Departments of Medicine (K.N., T.B.S., M.A.K., C.W.J.C.), Native Hawaiian Health (T.B.S.), and Surgery (C.W.J.C.), John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; and the Department of Neurology and Neurosurgery, University of California, San Francisco, CA (J.C.H.).

Abstract

BACKGROUND AND PURPOSE:

Studies show that women are more likely to receive do-not-resuscitate (DNR) orders after acute medical illnesses than men. However, the sex differences in the use of DNR orders after acute intracerebral hemorrhage (ICH) have not been described.

METHODS:

We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were performed to test for associations between female sex and early (<24 hours of presentation) DNR orders.

RESULTS:

A total of 372 consecutive ICH patients without preexisting DNR orders were studied. Overall, 82 (22%) patients had early DNR orders after being hospitalized with ICH. In the fully adjusted model, early DNR orders were more likely in women (odds ratio, 3.18; 95% confidence interval, 1.51-6.70), higher age (odds ratio, 1.09 per year; 95% confidence interval, 1.05-1.12), larger ICH volume (odds ratio, 1.01 per cm(3); 95% confidence interval, 1.01-1.02), and lower initial GCS score (odds ratio, 0.76 per point; 95% confidence interval, 0.69-0.84). Early DNR orders were less likely when the patients were transferred from another hospital (odds ratio, 0.28, 95% confidence interval, 0.11-0.76).

CONCLUSIONS:

Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.

KEYWORDS:

intracerebral hemorrhage; sex differences; terminal care

PMID:
23982712
PMCID:
PMC4297212
DOI:
10.1161/STROKEAHA.113.002814
[Indexed for MEDLINE]
Free PMC Article
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