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. 2012 Aug 28;79(9):941-4.
doi: 10.1212/WNL.0b013e318266fc40.

Early stroke mortality, patient preferences, and the withdrawal of care bias

Adam G Kelly  1 , Kathryn D Hoskins, Robert G Holloway
Affiliations

Early stroke mortality, patient preferences, and the withdrawal of care bias

Adam G Kelly et al. Neurology. .

Abstract

Objective: Early mortality is a potential measure of the quality of care provided to hospitalized stroke patients. Whether in-hospital stroke mortality is reflective of deviations from evidence-based practices or patient/family preferences on life-sustaining measures is unclear.

Methods: All ischemic stroke mortalities at an academic medical center were reviewed to better understand the causes of inpatient stroke mortality.

Results: Among 37 deaths or discharges to hospice in 2009, 36 occurred after a patient/family decision to withdraw/withhold potentially life-sustaining interventions. An independent survey of 3 vascular neurologists revealed that some early deaths could have been delayed beyond 30 days if patients or families had agreed to more aggressive measures. From these data, we estimate the magnitude of a "withdrawal of care" bias to be approximately 40% of the observed short-term mortality.

Conclusions: Acute stroke mortality may be more reflective of patient/family preferences than the provision of evidence-based care.

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References

    1. Kelly A, Thompson JP, Tuttle D, Benesch C, Holloway RG. Public reporting of quality data for stroke: is it measuring quality? Stroke 2008;39:3367–3371 - PMC - PubMed
    1. Jaren O, Selwa L. Causes of mortality on a university hospital neurology service. Neurologist 2006;12:245–248 - PubMed
    1. Holloway RG, Ladwig S, Robb J, Kelly A, Nielsen E, Quill TE. Palliative care consultations in hospitalized stroke patients. J Palliat Med 2010;13:407–412 - PMC - PubMed
    1. Holloway RG, Quill TE. Mortality as a measure of quality: implications for palliative and end-of-life care. JAMA 2007;298:802–804 - PubMed
    1. Adams HP, Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke 2007;38:1655–1711 - PubMed

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