• Lewis B Morgenstern, Darin B Zahuranec, Brisa N Sánchez, Kyra J Becker, Madeleine Geraghty, Rebecca Hughes, Gregory Norris, and J Claude Hemphill.
• From Stroke Program, Department of Neurology (L.B.M., D.B.Z., R.H.), and Department of Neurosurgery (L.B.M.), University of Michigan Health System, Ann Arbor; Departments of Epidemiology (L.B.M.) and Biostatistics (B.N.S.), University of Michigan School of Public Health, Ann Arbor; Department of Neurology (K.J.B.), University of Washington School of Medicine, Seattle; Department of Neurology (M.G.), Providence Sacred Heart Hospital, Spokane, WA; Department of Neurology (G.N.), Wayne State School of Medicine, Detroit, MI; Departments of Neurology (J.C.H.) and Neurological Surgery (J.C.H.), University of California, San Francisco School of Medicine. lmorgens@umich.edu.
• Neurology. 2015 Apr 28;84(17):1739-44.

ObjectiveThis study tested the hypothesis that patients without placement of new do-not-resuscitate (DNR) orders during the first 5 days after intracerebral hemorrhage (ICH) have lower 30-day mortality than predicted by the ICH Score without an increase in severe disability at 90 days.MethodsThis was a prospective, multicenter, observational cohort study at 4 academic medical centers and one community hospital. Adults (18 years or older) with nontraumatic spontaneous ICH, Glasgow Coma Scale score of 12 or less, who did not have preexisting DNR orders were included.ResultsOne hundred nine subjects were enrolled. Mean age was 62 years; median Glasgow Coma Scale score was 7, and mean hematoma volume was 39 cm(3). Based on ICH Score prediction, the expected overall 30-day mortality rate was 50%. Observed mortality was substantially lower at 20.2%, absolute average difference 29.8% (95% confidence interval: 21.5%-37.7%). At 90 days, 27.1% had died, 21.5% had a modified Rankin Scale score = 5 (severe disability). A good outcome (modified Rankin Scale score 0-3) was achieved by 29.9% and an additional 21.5% fell into the moderately severe disability range (modified Rankin Scale score = 4).ConclusionsAvoidance of early DNR orders along with guideline concordant ICH care results in substantially lower mortality than predicted. The observed functional outcomes in this study provide clinicians and families with data to determine the appropriate goals of treatment based on patients' wishes.© 2015 American Academy of Neurology.

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