Misunderstanding DNR Orders Can Be Deadly
March 16, 2018
The Jerusalem Post – BGU, Soroka University Medical Center and colleagues in the United States, Australia and Singapore discover that patients who arrive at an intensive-care unit with a do-not-resuscitate order face a significantly higher risk of dying within 28 days than those who come to an ICU without a DNR.
In the article published in the journal Critical Care Medicine, the researchers suggested that doctors interpret DNR orders more broadly than they were often intended – to mean fewer treatments and medicines – where the original order was a particular directive not to attempt cardiopulmonary resuscitation in specific circumstances.
The study, led by Dr. Lior Fuchs and Prof. Victor Novack of BGU’s Faculty of Health Sciences, analyzed a total of 19,007 patients that were admitted to the ICU between 2001 and 2008. Of those, 1,239 had a DNR order on the day of admission and survived the first 48 hours.
“Looking at 28-day mortality, the rates were significantly higher in the DNR group (33.9 percent vs. 18.4 percent),” says Dr. Novack. This is the first study to report on DNR association with mortality in the cohort of patients admitted to the ICUs, he explained.
The researchers found that patients with DNR orders received mechanical ventilation less frequently, fewer radiological investigations and had fewer medications prescribed.
“The discrepancy in understanding the DNR order by the treatment team could be partially the problem,” says Dr. Novack.