In this very interesting study, Nakagawa and colleagues explored who is more likely to get an early DNR status (within 24h after the admission) after ICH. Data was retrospectively acquired for the ICH patients in the tertiary stroke center over the period of 4 years. 396 patients were identified with ICH, however 24 had preexisting DNR and were excluded from the study. Even in this population, women were more likely to have preexisting DNR.
372 patients were studied. Women were more likely to receive an early DNR order compared to men (OR 2.24, 95% CI 1.36 to 3.70) in unadjusted analysis and also in multivariable analysis (OR 3.18, 95% CI 1.51 to 6.70).
Also, higher age (OR 1.09 per year, 95% CI 1.05 to 1.12), larger ICH volume (OR 1.01 per cm3, 95% CI 1.01 to 1.02), and lower initial GCS score (OR 0.76 per point, 95% CI 0.69 to 0.84) were also independently associated with early DNR orders as one would expect.
This data is interesting from two angles. First is why women have more frequent preexisting DNR. Do women themselves wish to have less aggressive management when faced with catastrophic illness such as ICH, leading to cardiopulmonary arrest? Second, once they have ICH, surrogate decision-maker makes decision on the DNR status. It would be really interesting to further explore what are the factors influencing these discrepancies.