Table 3.
Trends from 1991–97 for the Risk of Death During the 30 Days after a Do-not-resuscitate (DNR) Order Was Written*
| Study Year, % Dead | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Condition, DNR Status | '91 | '92 | '93 | '94 | '95 | '96 | '97 | Adjusted RR for Trend '91–'97 (95% CI)† | P Value |
| Acute myocardial infarction | |||||||||
| Early DNR (N = 1,552) | 67.6 | 50.0 | 62.7 | 55.3 | 60.0 | 52.8 | 51.2 | 0.96 (0.81 to 1.08) | .52 |
| Late DNR (N = 629) | 72.0 | 74.6 | 66.7 | 71.7 | 64.0 | 51.0 | 64.9 | 0.81 (0.60 to 0.98) | .03 |
| Congestive heart failure | |||||||||
| Early DNR (N = 2,819) | 35.0 | 37.8 | 35.8 | 33.2 | 33.0 | 30.5 | 30.9 | 0.86 (0.69 to 1.05) | .14 |
| Late DNR (N = 1,005) | 55.4 | 50.5 | 51.9 | 46.7 | 53.7 | 45.0 | 49.3 | 0.97 (0.78 to 1.17) | .80 |
| Gastrointestinal hemorrhage | |||||||||
| Early DNR (N = 1,469) | 38.8 | 30.7 | 27.5 | 27.4 | 27.3 | 29.6 | 29.3 | 0.98 (0.73 to 1.26) | .90 |
| Late DNR (N = 333) | 51.7 | 47.4 | 55.1 | 50.0 | 57.1 | 65.1 | 48.0 | 1.17 (0.80 to 1.49) | .36 |
| COPD | |||||||||
| Early DNR (N = 749) | 30.6 | 15.0 | 25.9 | 25.9 | 27.3 | 20.0 | 29.0 | 1.08 (0.70 to 1.55) | .71 |
| Late DNR (N = 303) | 56.5 | 57.5 | 57.1 | 51.6 | 68.1 | 61.5 | 46.5 | 1.07 (0.72 to 1.37) | .70 |
| Pneumonia | |||||||||
| Early DNR (N = 5,271) | 39.6 | 41.3 | 39.4 | 39.7 | 41.0 | 40.7 | 42.3 | 1.04 (0.91 to 1.17) | .57 |
| Late DNR (N = 1,582) | 61.6 | 58.0 | 59.3 | 56.7 | 56.6 | 56.7 | 55.3 | 0.93 (0.78 to 1.07) | .31 |
| Stroke | |||||||||
| Early DNR (N = 2,717) | 51.2 | 41.8 | 44.7 | 41.4 | 45.8 | 49.2 | 50.7 | 1.21 (1.08 to 1.34) | .002 |
| Late DNR (N = 955) | 52.1 | 54.0 | 54.7 | 55.6 | 53.0 | 67.4 | 61.3 | 1.25 (1.05 to 1.42) | .01 |
*
A DNR order was defined as “early” if it was written on the first or second day of hospitalization and “late” if written any time after that.
†
Adjusted for admission severity of illness (predicted 30-day mortality), probability of having an early or late DNR order written, and the hospital day on which the DNR order was written. 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.