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Code status documentation at admission in COVID-19 patients: a descriptive cohort study.
Briedé, Saskia; van Goor, Harriet M R; de Hond, Titus A P; van Roeden, Sonja E; Staats, Judith M; Oosterheert, Jan Jelrik; van den Bos, Frederiek; Kaasjager, Karin A H.
  • Briedé S; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands s.briede-2@umcutrecht.nl.
  • van Goor HMR; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • de Hond TAP; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • van Roeden SE; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Staats JM; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • Oosterheert JJ; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
  • van den Bos F; Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
  • Kaasjager KAH; Internal Medicine and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
BMJ Open ; 11(11): e050268, 2021 11 10.
Article in English | MEDLINE | ID: covidwho-1511474
ABSTRACT

OBJECTIVES:

The COVID-19 pandemic pressurised healthcare with increased shortage of care. This resulted in an increase of awareness for code status documentation (ie, whether limitations to specific life-sustaining treatments are in place), both in the medical field and in public media. However, it is unknown whether the increased awareness changed the prevalence and content of code status documentation for COVID-19 patients. We aim to describe differences in code status documentation between infectious patients before the pandemic and COVID-19 patients.

SETTING:

University Medical Centre of Utrecht, a tertiary care teaching academic hospital in the Netherlands.

PARTICIPANTS:

A total of 1715 patients were included, 129 in the COVID-19 cohort (a cohort of COVID-19 patients, admitted from March 2020 to June 2020) and 1586 in the pre-COVID-19 cohort (a cohort of patients with (suspected) infections admitted between September 2016 to September 2018). PRIMARY AND SECONDARY OUTCOME

MEASURES:

We described frequency of code status documentation, frequency of discussion of this code status with patient and/or family, and content of code status.

RESULTS:

Frequencies of code status documentation (69.8% vs 72.7%, respectively) and discussion (75.6% vs 73.3%, respectively) were similar in both cohorts. More patients in the COVID-19 cohort than in the before COVID-19 cohort had any treatment limitation as opposed to full code (40% vs 25%). Within the treatment limitations, 'no intensive care admission' (81% vs 51%) and 'no intubation' (69% vs 40%) were more frequently documented in the COVID-19 cohort. A smaller difference was seen in 'other limitation' (17% vs 9%), while 'no resuscitation' (96% vs 92%) was comparable between both periods.

CONCLUSION:

We observed no difference in the frequency of code status documentation or discussion in COVID-19 patients opposed to a pre-COVID-19 cohort. However, treatment limitations were more prevalent in patients with COVID-19, especially 'no intubation' and 'no intensive care admission'.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2021-050268

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Observational study / Prognostic study Limits: Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2021-050268