Do-not-resuscitate orders among trauma patients

Background Do-not-resuscitate (DNR) orders are an important means to communicate end-of-life wishes. Previous studies have demonstrated variable prevalence of DNR orders among hospitalized trauma patients. Objective This study was conducted to identify the prevalence and type of DNR orders among trauma patients and to identify associations of DNR orders with injury severity, length of stay, and whether CPR was performed in cases of cardiac arrest. Methods In this retrospective study, medical records were reviewed for 263 trauma patients at Miami Valley Hospital in Dayton, Ohio, in 2014 with a DNR order. Results Among 3394 trauma patients in 2014, 263 (8%) patients had a DNR order. Participants were 43% male and 57% female. The mean age was 76 (range, 16-90 +) years. The most common mechanisms of injury included fall (n = 214, 81.4%) and motor vehicle collision (n = 16, 6.1%). Most DNR orders in this patient population were instituted during the hospitalization (n = 176, 67%). The most common types of advance directives included DNR order (n = 224, 85.2%), living will (n = 124, 47.2%), and durable power of health care attorney (n = 126, 47.9%). A minority of patients died during hospitalization (n = 100, 38.0%). Among patients who were deceased, 14 (14.0%) had CPR performed. Conclusions Among trauma patients with DNR orders, most DNR orders were instituted during the hospital admission. Most deceased patients with DNR orders did not have CPR performed during the hospital stay.