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From hopeful to hopeless ... when do we write "do not resuscitate"?
Focus on Critical Care
|December 1, 1991
Summary
Do Not Resuscitate (DNR) decisions for burned patients are often made within 48 hours of death. Factors like sex or burn severity did not significantly influence DNR timing, highlighting complex decision-making factors.
Area of Science:
- Medical Ethics
- Trauma Surgery
- Critical Care Medicine
Background:
- Do Not Resuscitate (DNR) decisions are critical in end-of-life care.
- The timing and determinants of DNR orders in critically ill patients, particularly burn victims, require further investigation.
Purpose of the Study:
- To investigate the factors influencing the timing of Do Not Resuscitate (DNR) decisions in deceased burn patients.
- To analyze the relationship between patient demographics, injury severity, and DNR order placement.
Main Methods:
- Retrospective chart review of 70 deceased burn patients (1986-1988).
- Analysis of demographic data, percentage of body surface area burned, and timing of DNR orders.
- Interviews with healthcare professionals and legal/coroner officials.
Main Results:
- In 74% of cases, DNR decisions were made within 48 hours of patient death.
- No statistically significant differences were observed in sex distribution or percentage of body surface area burned between DNR and resuscitation groups.
- Interviews revealed uncertainty in legal guidelines and family expectations as barriers to uniform DNR decision-making.
Conclusions:
- DNR decisions in burn patients are frequently made very close to the time of death.
- The timing of DNR orders appears independent of patient sex or burn severity.
- Legal ambiguities and family dynamics complicate standardized approaches to DNR decisions in burn care.