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Prabhakaran S, Cox M, Lytle B, et al. Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry. Neurol Clin Pract. 2017;7(3):194-204doi: 10.1212/CPJ.0000000000000358.
Prabhakaran, S., Cox, M., Lytle, B., Schulte, P. J., Xian, Y., Zahuranec, D., Smith, E. E., Reeves, M., Fonarow, G. C., & Schwamm, L. H. (2017). Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry. Neurology. Clinical practice, 7(3), 194-204. https://doi.org/10.1212/CPJ.0000000000000358
Prabhakaran, Shyam, et al. "Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry." Neurology. Clinical practice vol. 7,3 (2017): 194-204. doi: https://doi.org/10.1212/CPJ.0000000000000358
Prabhakaran S, Cox M, Lytle B, Schulte PJ, Xian Y, Zahuranec D, Smith EE, Reeves M, Fonarow GC, Schwamm LH. Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry. Neurol Clin Pract. 2017 Jun;7(3):194-204. doi: 10.1212/CPJ.0000000000000358. PMID: 28680764; PMCID: PMC5490382.
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Neurol Clin Pract. 2017 Jun;7(3):194-204. doi: 10.1212/CPJ.0000000000000358.

Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry.

Neurology. Clinical practice

Shyam Prabhakaran, Margueritte Cox, Barbara Lytle, Phillip J Schulte, Ying Xian, Darin Zahuranec, Eric E Smith, Mathew Reeves, Gregg C Fonarow, Lee H Schwamm

Affiliations

  1. Feinberg School of Medicine (SP), Northwestern University, Chicago, IL; Duke Clinical Research Institute (MC, BL, PJS, YX), Durham, NC; University of Michigan (DZ), Ann Arbor; Hotchkiss Brain Institute (EES), University of Calgary, Canada; Michigan State University (MR), East Lansing; Ahmanson Cardiomyopathy Center (GCF), UCLA, Los Angeles, CA; Stroke Service (LHS), Massachusetts General Hospital, Boston; and Duke University Medical Center (YX), Durham, NC.

PMID: 28680764 PMCID: PMC5490382 DOI: 10.1212/CPJ.0000000000000358

Abstract

BACKGROUND: Death after acute stroke often occurs after forgoing life-sustaining interventions. We sought to determine the patient and hospital characteristics associated with an early decision to transition to comfort measures only (CMO) after ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Get With The Guidelines-Stroke registry.

METHODS: We identified patients with IS, ICH, or SAH between November 2009 and September 2013 who met study criteria. Early CMO was defined as the withdrawal of life-sustaining treatments and interventions by hospital day 0 or 1. Using multivariable logistic regression, we identified patient and hospital factors associated with an early (by hospital day 0 or 1) CMO order.

RESULTS: Among 963,525 patients from 1,675 hospitals, 54,794 (5.6%) had an early CMO order (IS: 3.0%; ICH: 19.4%; SAH: 13.1%). Early CMO use varied widely by hospital (range 0.6%-37.6% overall) and declined over time (from 6.1% in 2009 to 5.4% in 2013;

CONCLUSIONS: Early CMO was utilized in about 5% of stroke patients, being more common in ICH and SAH than IS. Early CMO use varies widely between hospitals and is influenced by patient and hospital characteristics.

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