Abstract
Background
It is common for patients who die from subarachnoid hemorrhage to have a focus on comfort measures at the end of life. The potential role of ethnicity in end-of-life decisions after brain injury has not been extensively studied.
Methods
Patients with subarachnoid hemorrhage were prospectively followed in an observational database. Demographic information including ethnicity was collected from medical records and self-reported by patients or their family. Significant in-hospital events including do-not-resuscitate orders, comfort measures only orders (CMO; care withheld or withdrawn), and mortality were recorded prospectively.
Results
1255 patients were included in our analysis: 650 (52 %) were White, 387 (31 %) Hispanic, and 218 (17 %) Black. Mortality was similar between the groups. CMO was more commonly observed in Whites (14 %) compared to either Blacks (10 %) or Hispanics (9 %) (p = 0.04). In a multivariate analysis controlling for age and Hunt-Hess grade, Hispanics were less likely to have CMO than Whites (OR, 0.6; 95 %CI, 0.4–0.9; p = 0.02). Of the 229 patients who died, 77 % of Whites had CMO compared to 54 % of Blacks and 49 % of Hispanics (p < 0.01). In a multivariate analysis, Blacks (OR, 0.3; 95 %CI, 0.2–0.7; p < 0.01) and Hispanics (OR, 0.3; 95 %CI, 0.2–0.6; p < 0.01) were less likely to die with CMO orders than Whites.
Conclusion
After subarachnoid hemorrhage, Blacks and Hispanics are less likely to die with CMO orders than Whites. Further research to confirm and investigate the causes of these ethnic differences should be performed.
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Acknowledgments
We would like to acknowledge physicians, nurses and care givers in the Neurointensive care unit at New York Presbyterian Hospital- Columbia University for their unwavering dedication to their patients.
Funding
Vivian L Smith Foundation.
Conflict of interest
The authors declare they have no conflict of interest.
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Choi, H.A., Fernandez, A., Jeon, SB. et al. Ethnic Disparities in End-of-Life Care After Subarachnoid Hemorrhage. Neurocrit Care 22, 423–428 (2015). https://doi.org/10.1007/s12028-014-0073-x
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DOI: https://doi.org/10.1007/s12028-014-0073-x