Variability in care intensity have been brought to light by the COVID-19 epidemic. For a study, researchers sought to describe the level of care given to COVID-19 individuals who were hospitalized. Examine the prevalence and determinants of cardiopulmonary resuscitation (CPR), palliative care consultation, comfort-measures-only orders, and admission code status among patients hospitalized with COVID-19.
Data from a global registry of COVID-19-positive hospitalized patients were analyzed in the cross-sectional investigation. A proportional odds model assessed factors that predicted a more aggressive code status (full code) vs a less aggressive code status (i.e., Do Not Resuscitate, DNR). Logistic regression was performed to find the factors that predicted whether a decedent received palliative care, just comfort measures, or CPR at the time of death.
Over 179 locations, 29,923 patients were enrolled. About 90% (n = 15,273) of those having admission code status that could be verified chose Full Code. Full Code was more prevalent among patients (after adjusting for location) who were Black or Asian (ORs 1.82, 95% CIs 1.5-2.19; 1.78, 1.15-3.09 respectively, compared to White race), Hispanic (OR 1.89, CI 1.35-2.32), and male (OR 1.16, CI 1.0–1.33). Of the 4,951 deceased, 29% had palliative care consultation, 59% switched to comfort measures alone, and 29% required CPR. Non-White racial and ethnic groupings were more likely to require CPR and less likely to switch to comfort measures solely.
Full Code was the majority initial code status in this global cohort of COVID-19 patients, and it was more prevalent among patients of Black or Asian racial or ethnic origin, Hispanic ethnicity, or male gender. Future research can be guided by the findings to reduce care inequities.