PURPOSE: Very little data exists on the outcome of patients with partial code status. The goal of our study was to determine the outcome of these patients admitted to the medical intensive care unit (MICU), their MICU mortality, in-hospital mortality, and the percentage that changed their code status.
METHODS: A retrospective chart review was conducted on all patients with a partial code status admitted to the MICU of a tertiary care hospital from Jan 1st 2007 to Jan 1st 2008. Partial code status was defined as any combination of CPR, intubation, vasopressors, antiarrhythmics, and/or noninvasive mechanical ventilation.
RESULTS: Of 1068 MICU admissions, 74 patients were partial code upon admission; of these, 40% were admitted from the emergency room. The mean age was 74 (41–96), 53% were male and 53% were Caucasian. Sepsis was the most common admission diagnosis. Forty-nine percent of patients had a history of cancer. The mean Sepsis-related Organ Failure Assessment (SOFA) score was 7.6 (0–20) on admission. MICU mortality was 34%. In-hospital mortality was 55%. Mean SOFA score in non-survivors was 9.0 versus 5.9 in survivors (P<0.01). Specific types of partial code, history of cancer, and admission source were not statistically significant predictors of mortality. Thirty-six percent of patients with partial code status were subsequently changed to do not resuscitate/do not intubate.
CONCLUSION: Patients with partial code admitted to the MICU have a high mortality and were likely to have their code status altered. A higher SOFA score was a significant predictor of mortality, whereas the specific type of partial code was not.
CLINICAL IMPLICATIONS: Code discussions are an integral part of MICU care. This study adds data to the outcome of patients with partial code status. Further research needs to be done to facilitate end of life discussions with patients who prefer partial code.
DISCLOSURE: Christopher O Donnell, No Financial Disclosure Information; No Product/Research Disclosure Information