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Disease-specific criteria for DNR orders in acute stroke were discussed by 26 physicians in three rounds of the opinion survey.An agreement was reached that a"no resuscitation"decision is appropriate when any two of the following three clinical criteria are present(the degree of agreement is given in parentheses):severe stroke(88%,P=.00007),lifethreatening brain damage(73%,P<.01),and significant comorbidities(92%,P=.00003).The poor prognosis implied by these criteria should be discussed whenever possible among physician(s),the patient,and family members before the decision to withhold CPR is made.Eighty-one percent of the participants agreed that these disease-specific criteria are appropriate for clinical use(P=.0008). Disease-specific criteria for DNR orders were developed to supplement general DNR policies for patients with hemispheric brain infarction and intracerebral hemorrhage during the first 2 weeks of stroke.A significant agreement was reached by a panel of physicians that patients with acute stroke should not be resuscitated if these disease-specific criteria are met. |
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