Do-not-resuscitate status and the under use of palliative care negatively impact best care practices in patients who survive nontraumatic intracerebral hemorrhage (bleeding within the brain), according to two studies presented at the American Stroke Association’s International Stroke Conference 2015.

Intracerebral hemorrhage is a life-threatening bleeding stroke associated with substantial health issues and death risk. Studies have found DNRs negatively impact patients who survive this type of bleeding stroke, probably because of the inactive health management associated with the orders.

Researchers in one study found demographic, social and regional characteristics impact whether people have DNRs. They analyzed the records of nearly 25,800 patients who suffered non-traumatic intracerebral hemorrhage in 2011 and 2012. Of those, 18 percent had DNR orders placed. They found:

  • The likelihood of placing DNR orders was 1.2 times higher in women than men.
  • The odds of placing DNRs were 1.6 times more likely among Caucasians and 1.2 times more likely among Hispanics than African Americans.
  • The likelihood of placing DNRs was 1.1 times higher among Medicare and Medicaid patients and 1.1 times higher among self- or no-pay patients, than those with private insurance.
  • The odds of having DNR orders were 1.6 times more among the patients at hospitals in the West region of the United States than the Northeast. Other regions were not significantly different from the Northeast.

The reasons for these DNR use variations should be explored, the researchers said.

In another study, researchers examined whether patients with a poor prognosis after intracerebral hemorrhage received a palliative care consult while in the hospital. Palliative care, which focuses on managing pain and symptoms near the end of life, is an essential part of care for intracerebral hemorrhage patients with poor prognosis.

The researchers found that of 99 intracerebral patients who died or were discharged to hospice, only 23 percent received a palliative care consultation. Among the most severe ICH patients, only 28 percent received a palliative care consult, despite an expected 30-day mortality of 97 percent.

This raises concerns about palliative care underuse among patients who might benefit most, they said.