The timing of do-not-resuscitate orders and hospital costs.

The relation between the timing of do-not-resuscitate (DNR) orders and the cost of medical care is not well understood. This prospective observational study compares hospital costs and length of stay of 265 terminally ill patients with admission DNR orders, delayed DNR orders (occurring after 24 hours), or no DNR orders (full code). Patients whose orders remained full code throughout a hospital stay had similar lengths of stay, total hospital costs, and daily costs as patients with admission DNR orders. Patients with delayed DNR orders, by contrast, had a greater mortality, longer length of stay, and higher total costs than full code or admission DNR patients, but similar daily costs. The causes of delay in DNR orders and the associated higher costs are a matter for future research.

Clinical and radiological correlates of somatosensory evoked potentials in the late phase of head injury: a study of 500 Vietnam veterans.

Somatosensory evoked potentials were obtained after median nerve stimulation in 500 Vietnam veterans surviving penetrating head wounds 12-16 years earlier and 76 age-matched, uninjured controls. The results were studied in relation to neurologic history and findings, anatomical data provided by CT scan, and information derived from electroencephalograms. Thirty-five percent of head-injured individuals had abnormal SEPs and 76% of SEP abnormalities consisted of absence of N20 or N20/P25 complex. SEP abnormality correlated (P greater than 0.001) with the extent of total brain volume loss, sensory deficits (especially position and cortical discriminatory modalities), hemiparesis, organic mental disorder, CT evidence of parietal or thalamic injury, and centro-parietal EEG abnormalities. Recovery from hemiparesis was correlative with patients who subsequently had normal SEPs.

Clinical and radiological correlates of EEG in the late phase of head injury: a study of 515 Vietnam veterans.

Electroencephalograms were obtained in 515 Vietnam veterans 12-16 years after penetrating head injury, and the results were correlated with a variety of clinical and radiological parameters. Forty-two percent of EEGs were abnormal; 9% disclosed epileptiform findings (EF). EF correlated highly (P = 0.0001) with the extent of brain volume loss (defined by CT), posttraumatic epilepsy, and organic mental disorder. 'Seizure persistence' was higher and duration of posttraumatic epilepsy was longer in patients with 'prominent EF.' All patients with anterior temporal or central spike foci experienced posttraumatic seizures. Focal slowing correlated significantly with focal neurologic deficits such as hemisensory deficit or hemiparesis and Broca's aphasia as well as with seizures and residual organic mental disorder. Total or near total recovery from original hemiparesis was noted in 70% of the patients with normal EEG and 32% of the patients with focally slow tracings.

Surgically correctable lesions solely detected by CT scan in adult-onset chronic epilepsy.

A prospective study of 162 patients with adult-onset chronic epilepsy revealed 4 in whom computed tomographic scanning was the only diagnostic test that detected the presence of a surgically correctable cerebral lesion. These patients had suffered from seizures for 1 to 14 years and at the time of operation demonstrated no clinical neurological deficits except organic mental changes.