Community-acquired pneumonia and do not resuscitate orders

Area of Science:

• Pulmonology
• Critical Care Medicine
• Medical Ethics

Background:

• Community-acquired pneumonia (CAP) is a significant cause of hospitalization and mortality.
• Do not resuscitate (DNR) orders are crucial for end-of-life care decisions in hospitalized patients.
• Understanding the characteristics and outcomes of CAP patients with DNR orders is essential for clinical care and resource allocation.

Purpose of the Study:

• To identify and compare the characteristics of hospitalized CAP patients with and without a do not resuscitate (DNR) order.
• To analyze the outcomes, including mortality and length of stay, for CAP patients with and without DNR orders.
• To determine factors associated with the presence of a DNR order in CAP patients.

Main Methods:

• Retrospective analysis of data from the pneumonia patient outcomes research team study.
• Inclusion of hospitalized patients aged 18 and older diagnosed with CAP across four hospitals in the US and Canada.
• Comparison of sociodemographic features, illness severity, treatment, length of stay, and mortality between patients with and without DNR orders.

Main Results:

• Patients with DNR orders were older, more likely to be white, and came from chronic care facilities compared to those without DNR orders.
• DNR patients experienced longer hospital stays and had significantly higher 90-day mortality rates (43.2% for initial DNR, 61.5% for later DNR vs. 4.7% for no DNR).
• DNR orders were highly predictive of in-hospital mortality (negative predictive value of 98.9%), with most in-hospital deaths occurring in patients with DNR orders.

Conclusions:

• The majority of in-hospital deaths among CAP patients occur in those with a DNR order.
• Early DNR orders (within 24 hours) primarily reflect underlying comorbid conditions.
• Later DNR orders suggest a combination of comorbidity and the futility of further medical intervention.