Resuscitation: how do we decide? A prospective study of physicians' preferences and the clinical course of hospitalized patients
M. E. Charlson, F. L. Sax, C. R. MacKenzie, S. D. Fields, R. L. Braham and R. G. Douglas Jr
Physicians have to address the question of the measures to be employed in
the event that a patient's condition deteriorates after admission to the
hospital. To identify the information that physicians use in making such
decisions, all 604 patients admitted to the medical service during a
one-month period were studied. The patient's age and residents' estimates
of the patient's long-term prognosis and ability to function were the three
primary factors that correlated with intervention preferences. When illness
severity, the reason for admission, comorbidity, and poor function were
taken into account, mortality and morbidity rates did not differ between
patients for whom full vs not-full intervention was favored. Apart from
differential rates of admission to critical care units, there were no
important differences in the care, course, or mortality of patients for
whom less than full intervention was initially favored. Suggestions that
physicians should discuss resuscitation with all or most patients who may
die are unrealistic. A more prudent strategy is to discuss the issue with
patients whose hospital course is marked by a steady deterioration.
