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van CCT (UK)

van CCT (UK)

Resuscitation orders in Emergency Medicine

- candidate number28346
- NTR NumberNTR6954
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR14-dec-2017
- Secondary IDsM018-003 METC
- Public TitleResuscitation orders in Emergency Medicine
- Scientific TitleResuscitation Orders in Emergency Medicine: a retrospective study on the daily practice of registration of resuscitation orders in Dutch emergency departments
- hypothesisWith this descriptive study we aim to acquire more insight into the current practice of obligatory resuscitation order registration in the emergency department and to address its effectiveness.
- Healt Condition(s) or Problem(s) studiedResuscitation, Emergency department, Treatment limitation
- Inclusion criteriaAll adult patients admitted from the ED from participating hospitals
- Exclusion criterianone
- mec approval receivedno
- multicenter trialyes
- randomisedno
- group[default]
- Type[default]
- Studytypeobservational
- planned startdate 1-mrt-2018
- planned closingdate1-jan-2019
- Target number of participants0
- Interventionsnone
- Primary outcomefrequency of change in CPR status (as determined in the ED) during hospital stay
- Secondary outcomeWe plan to perform subgroup analyses to determine the patient characteristics that correlate with the group of patients for whom the CPR status was changed.
We determined the following patient characteristics:
- age (18-40, 40-50, 50-60, 60-70, 70-80, 80+)
- sex (F/M/other)
- amount of hospital admissions in the previous year (<3, =>3)
- comorbidities classified (using ICD-10 codes registered as part of the DBC system) as:
1. neoplasms
2. diabetes mellitus
3. liver insufficiency
4. cardiovascular disease
5. chronic respiratory disease
6. renal insufficiency
- ICU admissions (direct, delayed, no admission)
- compounded surrogate measure of frailty, yet to be defined
- reason for change in CPR status (medical futility/patient preference/not specified)
- family present during end-of-life conversation (yes/no/not specified)
- in case of IHCA: survivor or non-survivor

Predefined hospital and other characteristics:
- time of ED presentation (day shift 7:00-15:00, evening shift 15:00-22:00, night shift 22:00-7:00)
- which doctor registers CPR status (junior vs senior, ED vs other specialty)
- differences between hospitals
- in Westfriesgasthuis patients: comparison between frequency of CPR status registration in the ED and change in CPR status during admission before and after change of protocol (February 2017)
- Timepoints1-2018 protocol finished and acquire ethical approval
5-2018 data extracted from electronic patient files in all hospitals
7-2018 finish preparation of data set for analyses
8-2018 analysis
12-2018 first draft result report finished
- Trial web site
- statusplanned
- Sponsor/Initiator
- Funding
(Source(s) of Monetary or Material Support)
Westfriesgasthuis Hoorn, Spaarne gasthuis
- Publications
- Brief summaryIn many Dutch hospitals hospital admission from the emergency department (ED) requires registration of resuscitation orders. There is an ongoing debate addressing whether it is necessary to raise the end-of-life discussion with all patients admitted from the ED and whether the ED is really the most appropriate place to discuss such sensitive matters. This debate is primarily fed by ethical arguments. However, quantitative data on current CPR status registration practice and its effectiveness is lacking. The current proposal describes a multicenter retrospective case analysis aiming to generate these objective data to feed into this debate.
- Main changes (audit trail)
- RECORD14-dec-2017 - 26-jan-2018

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