Table 2.
Percentage of Patients for Whom a Do-not-resuscitate (DNR) Order Was Written on Hospital Day 1 or 2 (Early DNR) and on Hospital Day 3 or Later (Late DNR)
| Study Year, % | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Condition, DNR Status | '91 | '92 | '93 | '94 | '95 | '96 | '97 | Adjusted RR* '92 versus '91 (95% CI) | P Value | Adjusted RR for trend '92–'97* (95% CI) | P Value |
| Acute myocardial infarction | |||||||||||
| No DNR (N = 8,245) | 82.7 | 79.9 | 80.8 | 78.7 | 77.9 | 78.0 | 78.5 | 0.96 (0.91 to 1.00) | .04 | 0.99 (0.96 to 1.02) | .64 |
| Early DNR (N = 1,552) | 10.4 | 13.1 | 13.2 | 15.4 | 16.3 | 16.6 | 15.4 | 1.34 (1.04 to 1.71) | .02 | 1.01 (0.91 to 1.31) | .31 |
| Late DNR (N = 629) | 6.9 | 7.0 | 6.0 | 5.9 | 5.8 | 5.5 | 6.2 | 1.12 (0.85 to 1.48) | .42 | 0.91 (0.74 to 1.08) | .28 |
| Congestive heart failure | |||||||||||
| No DNR (N = 19,656) | 85.8 | 82.1 | 83.0 | 82.6 | 85.0 | 83.5 | 84.6 | 0.97 (0.92 to 1.01) | .14 | 1.04 (1.01 to 1.07) | .005 |
| Early DNR (N = 2,819) | 8.6 | 13.0 | 12.5 | 12.7 | 11.2 | 12.8 | 11.7 | 1.41 (1.03 to 1.90) | .03 | 0.84 (0.71 to 0.99) | .04 |
| Late DNR (N = 1,005) | 5.5 | 4.9 | 4.5 | 4.8 | 3.8 | 3.7 | 3.7 | 0.90 (0.69 to 1.18) | .45 | 0.71 (0.52 to 0.95) | .03 |
| GI hemorrhage | |||||||||||
| No DNR (N = 9,277) | 87.2 | 86.0 | 84.1 | 82.6 | 84.6 | 82.7 | 82.5 | 0.96 (0.88 to 1.02) | .18 | 1.02 (0.99 to 1.05) | .26 |
| Early DNR (N = 1,469) | 8.9 | 11.8 | 12.3 | 13.7 | 12.8 | 15.0 | 14.8 | 1.66 (1.08 to 2.46) | .02 | 0.96 (0.75 to 1.22) | .77 |
| Late DNR (N = 333) | 3.9 | 2.2 | 3.7 | 3.7 | 2.6 | 2.3 | 2.7 | 0.63 (0.34 to 1.14) | .13 | 0.62 (0.45 to 0.86) | .005 |
| COPD | |||||||||||
| No DNR (N = 7,432) | 88.7 | 83.9 | 87.4 | 86.8 | 86.8 | 90.0 | 88.0 | 0.92 (0.84 to 0.98) | .008 | 1.06 (1.03 to 1.10) | .001 |
| Early DNR (N = 749) | 6.9 | 9.7 | 9.2 | 9.1 | 10.1 | 7.3 | 8.7 | 1.62 (1.01 to 2.54) | .05 | 0.71 (0.54 to 0.95) | .02 |
| Late DNR (N = 303) | 4.3 | 6.4 | 3.4 | 4.1 | 3.2 | 2.7 | 3.0 | 1.76 (1.12 to 2.71) | .01 | 0.47 (0.30 to 0.71) | <.001 |
| Pneumonia | |||||||||||
| No DNR (N = 16,856) | 75.4 | 72.4 | 70.0 | 70.5 | 70.3 | 71.2 | 71.5 | 0.98 (0.92 to 1.03) | .43 | 1.06 (1.03 to 1.10) | .001 |
| Early DNR (N = 5,271) | 18.0 | 22.1 | 22.8 | 22.2 | 23.2 | 22.4 | 22.1 | 1.16 (0.91 to 1.46) | .23 | 0.82 (0.71 to 0.93) | .002 |
| Late DNR (N = 1,582) | 6.6 | 5.5 | 7.2 | 7.3 | 6.6 | 6.4 | 6.4 | 0.86 (0.68 to 1.06) | .18 | 0.84 (0.70 to 0.99) | .04 |
| Stroke | |||||||||||
| No DNR (N = 10,604) | 77.0 | 74.5 | 73.1 | 74.2 | 73.8 | 75.6 | 73.5 | 0.99 (0.92 to 1.05) | .71 | 1.01 (0.97 to 1.04) | .76 |
| Early DNR (N = 2,717) | 14.7 | 17.8 | 20.1 | 18.7 | 19.9 | 18.9 | 20.2 | 1.12 (0.90 to 1.38) | .30 | 1.04 (0.89 to 1.20) | .62 |
| Late DNR (N = 955) | 8.3 | 7.7 | 6.8 | 7.1 | 6.3 | 5.5 | 6.3 | 0.93 (0.63 to 1.36) | .72 | 0.82 (0.64 to 1.06) | .13 |
Relative risks (RR) and P values for the “No DNR” group are obtained from logistic regression models with “no DNR order” as the reference category. Relative risks and P values for the “Early DNR” and the “Late DNR” groups are obtained from multinomial logistic regression models with the “No DNR” group as the reference category. All models adjust for admission severity of illness, age, sex, race, admission from a nursing home, and hospital. Standard errors are adjusted for the clustering of patients within hospitals. For the 1992–1997 analysis, year was entered as a continuous variable ranging from 1992 = 0 to 1997 = 1. The β coefficients for year were used to estimate the change in the risk of having (a) an early DNR order, or (b) a late DNR order written in 1997 versus 1991 by exponentiating the β coefficient to obtain the odds ratios and then converting the odds ratios to relative risks using published formulas.