Abstract TP303: Gender Differences in the Use of Early Do-Not-Resuscitate Orders after Intracerebral Hemorrhage

Abstract

Background and Purpose: Studies show that women are more likely to receive do-not-resuscitate (DNR) orders after acute medical illnesses than men. However, the gender differences in the use of early (<24 hours of presentation) DNR order after acute intracerebral hemorrhage (ICH) has not been described. Methods: We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were used to test for associations between female gender and early DNR orders (<24 hours of presentation). Results: A total of 373 consecutive ICH patients without pre-existing DNR orders (NHPI 19%, Asians 62%, non-Hispanic whites 15% and other 4%) were studied. Unadjusted analysis showed that women were more likely to receive early DNR orders compared to men (odds ratio 2.26, 95% CI 1.37 to 3.72). In the fully adjusted model, the independent predictors of early DNR orders were female gender (odds ratio 3.21, 95% CI 1.52 to 6.78), age (odds ratio 1.08 per year, 95% CI 1.05 to 1.11), ICH volume (odds ratio 1.02 per cm3, 95% CI 1.01 to 1.03), initial GCS score (odds ratio 0.74 per point, 95% CI 0.66 to 0.82) and whether the patient was transferred from another hospital (odds ratio 0.28, 95% 0.11 to 0.76). When comparing gender-related outcome, mortality was not different between women and men (25% vs. 27%, p = 0.71). Conclusions: Women are more likely to receive early DNR orders after ICH than men. Further prospective study is needed to determine factors contributing to the gender variation in the use of early DNR order after ICH and whether this variation represents differences in patient preferences or preferences of the surrogate decision-makers.