Racial and Ethnic Differences in the Prevalence of Do-Not-Resuscitate Orders among Older Adults with Severe Traumatic Brain Injury.

Hatfield, Jordan; Fah, Megan; Girden, Alex; Mills, Brianna; Ohnuma, Tetsu; Haines, Krista; Cobert, Julien; Komisarow, Jordan; Williamson, Theresa; Bartz, Raquel; Vavilala, Monica; Raghunathan, Karthik; Tobalske, Anwen; Ward, Joshua; Krishnamoorthy, Vijay

Racial and Ethnic Differences in the Prevalence of Do-Not-Resuscitate Orders among Older Adults with Severe Traumatic Brain Injury.

dc.contributor.author	Hatfield, Jordan
dc.contributor.author	Fah, Megan
dc.contributor.author	Girden, Alex
dc.contributor.author	Mills, Brianna
dc.contributor.author	Ohnuma, Tetsu
dc.contributor.author	Haines, Krista
dc.contributor.author	Cobert, Julien
dc.contributor.author	Komisarow, Jordan
dc.contributor.author	Williamson, Theresa
dc.contributor.author	Bartz, Raquel
dc.contributor.author	Vavilala, Monica
dc.contributor.author	Raghunathan, Karthik
dc.contributor.author	Tobalske, Anwen
dc.contributor.author	Ward, Joshua
dc.contributor.author	Krishnamoorthy, Vijay
dc.date.accessioned	2022-06-20T19:34:12Z
dc.date.available	2022-06-20T19:34:12Z
dc.date.issued	2022-05-22
dc.date.updated	2022-06-20T19:34:11Z
dc.description.abstract	Background Older adults suffering from traumatic brain injury (TBI) are subject to higher injury burden and mortality. Do Not Resuscitate (DNR) orders are used to provide care aligned with patient wishes, but they may not be equitably distributed across racial/ethnic groups. We examined racial/ethnic differences in the prevalence of DNR orders at hospital admission in older patients with severe TBI. Methods We conducted a retrospective cohort study using the National Trauma Databank (NTDB) between 2007 to 2016. We examined patients ≥ 65 years with severe TBI. For our primary aim, the exposure was race/ethnicity and outcome was the presence of a documented DNR at hospital admission. We conducted an exploratory analysis of hospital outcomes including hospital mortality, discharge to hospice, and healthcare utilization (intracranial pressure monitor placement, hospital LOS, and duration of mechanical ventilation). Results Compared to White patients, Black patients (OR 0.48, 95% CI 0.35-0.64), Hispanic patients (OR 0.54, 95% CI 0.40-0.70), and Asian patients (OR 0.63, 95% CI 0.44-0.90) had decreased odds of having a DNR order at hospital admission. Patients with DNRs had increased odds of hospital mortality (OR 2.16, 95% CI 1.94-2.42), discharge to hospice (OR 2.08, 95% CI 1.75-2.46), shorter hospital LOS (-2.07 days, 95% CI -3.07 to -1.08) and duration of mechanical ventilation (-1.09 days, 95% CI -1.52 to -0.67). There was no significant difference in the utilization of ICP monitoring (OR 0.94, 95% CI 0.78-1.12). Conclusions We found significant racial and ethnic differences in the utilization of DNR orders among older patients with severe TBI. Additionally. DNR orders at hospital admission were associated with increased in-hospital mortality, increased hospice utilization, and decreased healthcare utilization. Future studies should examine mechanisms underlying race-based differences in DNR utilization.
dc.identifier.issn	0885-0666
dc.identifier.issn	1525-1489
dc.identifier.uri	https://hdl.handle.net/10161/25387
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	Journal of intensive care medicine
dc.relation.isversionof	10.1177/08850666221103780
dc.subject	DNR order
dc.subject	do not resuscitate
dc.subject	ethnicity
dc.subject	traumatic brain injury
dc.title	Racial and Ethnic Differences in the Prevalence of Do-Not-Resuscitate Orders among Older Adults with Severe Traumatic Brain Injury.
dc.type	Journal article
duke.contributor.orcid	Ohnuma, Tetsu\|0000-0002-2303-6802
duke.contributor.orcid	Haines, Krista\|0000-0002-2056-1820
duke.contributor.orcid	Komisarow, Jordan\|0000-0003-3919-7931
duke.contributor.orcid	Raghunathan, Karthik\|0000-0003-2809-5374
duke.contributor.orcid	Krishnamoorthy, Vijay\|0000-0002-1365-4121\|0000-0003-4153-2348
pubs.begin-page	8850666221103780
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Basic Science Departments
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Anesthesiology
pubs.organisational-group	Anesthesiology, Critical Care Medicine
pubs.organisational-group	Surgery
pubs.organisational-group	Trauma, Acute, and Critical Care Surgery
pubs.organisational-group	Neurology
pubs.organisational-group	Neurology, Neurocritical Care
pubs.organisational-group	Neurosurgery
pubs.organisational-group	Population Health Sciences
pubs.publication-status	Published