Title
Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19
Date Issued
01 October 2022
Access level
open access
Resource Type
journal article
Author(s)
Kiker W.A.
Cheng S.
Pollack L.R.
Creutzfeldt C.J.
Kross E.K.
Curtis J.R.
Belden K.A.
Melamed R.
Armaignac D.L.
Heavner S.F.
Christie A.B.
Banner-Goodspeed V.M.
Khanna A.K.
Sili U.
Anderson H.L.
Kumar V.
Walkey A.
Kashyap R.
Gajic O.
Khandelwal N.
Mayo Clinic
Publisher(s)
Elsevier Inc.
Abstract
Context: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19. Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19. Methods: This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death. Results: We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5–2.19; 1.78, 1.15–3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35–2.32), and male sex (OR 1.16, CI 1.0–1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR. Conclusion: In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.
Start page
359
End page
369
Volume
64
Issue
4
Language
English
OCDE Knowledge area
Medicina clínica Salud pública, Salud ambiental
Scopus EID
2-s2.0-85135146479
PubMed ID
Source
Journal of Pain and Symptom Management
ISSN of the container
08853924
Sponsor(s)
Financial Support: This project was supported by the National Institutes of Health (Grants T32HL125195 and K23HL144830), and by NIH/NCRR/NCATS CTSA Grant Number UL1 TR002377. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The registry is funded in part by the Gordon and Betty Moore Foundation, and Janssen Research & Development, LLC. They had no influence on analysis, interpretation and reporting of pooled data.
Sources of information: Directorio de Producción Científica Scopus