Race is a Predictor of Withdrawal of Life Support in Patients with Intracerebral Hemorrhage

J Stroke Cerebrovasc Dis. 2018 Nov;27(11):3108-3114. doi: 10.1016/j.jstrokecerebrovasdis.2018.07.006. Epub 2018 Aug 16.

Abstract

Introduction: Medical and socioeconomic factors may impact decisions to change the goals of care for patients with intracerebral hemorrhage (ICH) to comfort measures only.

Methods: We reviewed prospectively collected data on patients with ICH, including baseline patient demographics, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), and ICH score. We conducted multivariable logistic regression analysis to identify predictors of change to comfort measures only status.

Results: Of 198 patients included in the analysis, 39 (19.7%) were made comfort measures only. Age, gender, insurance status, substance use, and medical comorbidities were similar between groups. Race was significantly different between the comfort measures only (black 15.4%, white 51.3%, other 33.3%) and noncomfort measures only groups (black 39.6%, white 45.9%, other 14.5%; P = .003). Patients changed to comfort measures only had higher mean income based on zip code ($59,264 versus $49,916; P = .021), higher median NIHSS (23 versus 16; P = .0001), higher ICH score (2.7 versus 1.5; P < .0001), lower median GCS (7 versus 13; P < .0001). Following multivariable analysis, factors associated with comfort measures only were GCS odds ratio (OR) 0.77, 95% confidence interval (CI) 0.68-0.86, P < .0001), intraventricular hemorrhage (IVH) volume (OR 1.03, 95% CI 1.01-1.06, P = .002), and black race (OR 0.24, 95% CI 0.07-0.82, P = .022). Mortality, poor outcome, and hospital length of stay were not significantly different between black and white patients.

Conclusions: Lower GCS score, higher IVH volume, and race were independent predictors of comfort measures only. Black patients were 76% less likely to withdraw life support than white patients. There were no significant differences in mortality between black and white patients. Providers should be aware of potential racial disparities.

Keywords: Goals of care; Hemorrhage; ICH; Intracerebral hemorrhage; Race; Socioeconomic status; Stroke.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Black or African American*
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / ethnology*
  • Cerebral Hemorrhage / mortality
  • Cerebral Hemorrhage / therapy*
  • Clinical Decision-Making*
  • Female
  • Glasgow Coma Scale
  • Healthcare Disparities / ethnology*
  • Hospital Mortality / ethnology
  • Humans
  • Income
  • Life Support Care*
  • Male
  • Middle Aged
  • Patient Comfort
  • Residence Characteristics
  • Risk Factors
  • Texas / epidemiology
  • White People*
  • Withholding Treatment*