Racial disparities in end-of-life suffering within surgical intensive care units

Area of Science:

• Critical Care Medicine
• Palliative Care
• Health Services Research

Background:

• End-of-life (EOL) care is resource-intensive.
• Recognizing and communicating EOL improves patient-centered care and reduces futile interventions.
• Provider assessment of futility in the SICU may influence Do Not Resuscitate (DNR) status.

Purpose of the Study:

• To investigate the association between provider assessment of expected survival and DNR status in SICU patients.
• To examine race-based differences in DNR status among deceased SICU patients.

Main Methods:

• Retrospective review of a prospective SICU registry (2018-2022).
• Inclusion of subjective provider assessment of expected survival.
• Multivariable logistic regression to adjust for clinical factors and assess associations with code status and race.

Main Results:

• 26.3% of deaths were anticipated by ICU providers.
• Expected death correlated with higher odds of DNR for non-trauma patients (OR 1.8), but not trauma patients (OR 0.82).
• Black patients were less likely to have DNR status (OR 0.49) after adjustment.

Conclusions:

• 20% of deceased SICU patients lacked DNR status.
• Injured Black patients were more likely to be full code at death.
• Further evaluation is needed to optimize EOL recognition and communication to prevent suffering.