What is it about?
Most patients with terminal COPD had DNR directives, however only 30% of DNR decisions were made prior to their last (terminal) hospital admission. Factors associated with early DNR decisions were aged (OR=1.07; 95% CI: 1.02–1.12), increased ER visits (OR=1.22; 95% CI: 1.10–1.37), rapid decline in lung function (OR=3.42; 95% CI: 1.12–10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07–8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10–5.19).
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Why is it important?
We currently report that despite 86.3% of patients with terminal COPD having DNR directives in a teaching hospital in Taiwan, only 11.1% had their terminal status documented by a physician, and 70% of DNR directives were made in the last admission before death.
Perspectives
We found some important factors associated with early DNR decisions makings. Using these predictive factors in existing EHR (electronic health record) databases to help patients, their surrogates, and primary care physicians to share decision making in advanced COPD is warranted in the future.
Dr. Pin-Kuei Fu
Taichung Veterans General Hospital
Read the Original
This page is a summary of: Early and late do-not-resuscitate (DNR) decisions in patients with terminal COPD: a retrospective study in the last year of life, International Journal of Chronic Obstructive Pulmonary Disease, August 2018, Dove Medical Press,
DOI: 10.2147/copd.s168049.
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