{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:11:18Z","timestamp":1790856678880,"version":"4.1.0"},"reference-count":35,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["2022YFS0279"],"award-info":[{"award-number":["2022YFS0279"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,28]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>An ED in a tertiary hospital in western China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>2001 patients (aged \u226518 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)\/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p&lt;0.001) and more likely to have comorbidities. DNR status was associated with higher in-hospital (17.8% vs 6.5%, p&lt;0.001) and 30-day (32% vs 12%, p&lt;0.001) mortality. However, there were no significant differences in intensive care unit (ICU) admission (64.2% vs 58.8%, p=0.148), ICU length of stay (41.0\u2009hours vs 45.4\u2009hours, p=0.834) or vasopressor use (29.8% vs 25.5%, p=0.082). Logistic regression analysis revealed that ICU admission was associated with the number of antibiotics (p=0.010), vasopressor use (p&lt;0.001) and initial lactate level (p=0.026) but not DNR status (p=0.650). Furthermore, DNR status neither affected vasopressor administration (OR=0.888, 95% CI: 0.671 to 1.174, p=0.405) nor antibiotic administration (OR=1.484, 95% CI: 1.052 to 2.092, p=0.024).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099709","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T06:20:32Z","timestamp":1758262832000},"page":"e099709","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Do-not-resuscitate status in patients with shock in the emergency department in a tertiary hospital in China: a retrospective observational study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7781-2993","authenticated-orcid":false,"given":"Haihong","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianjing","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weifan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2430-4493","authenticated-orcid":false,"given":"Qinqin","family":"Wu","sequence":"additional","affiliation":[{"name":"Health Management Center,General Practice Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"2025091823201584000_15.9.e099709.1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.4.941"},{"key":"2025091823201584000_15.9.e099709.2","doi-asserted-by":"crossref","DOI":"10.1186\/cc9972","article-title":"Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department","volume":"15","author":"Merz","year":"2011","journal-title":"Crit Care"},{"key":"2025091823201584000_15.9.e099709.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0119331","article-title":"Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review","volume":"10","author":"Holler","year":"2015","journal-title":"PLoS 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sepsis in the medical intensive care unit: a retrospective, observational and propensity score-matched study in a tertiary referral hospital in Taiwan","volume":"9","author":"Chang","year":"2019","journal-title":"BMJ Open"},{"key":"2025091823201584000_15.9.e099709.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2008.01.007"},{"key":"2025091823201584000_15.9.e099709.10","doi-asserted-by":"publisher","DOI":"10.1177\/0269216314526272"},{"key":"2025091823201584000_15.9.e099709.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"2025091823201584000_15.9.e099709.12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1214\/18-STS646","article-title":"Multiple Imputation for Multilevel Data with Continuous and Binary Variables","volume":"33","author":"Audigier","year":"2018","journal-title":"Statist 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