Abstract
Purpose: For some critically ill children, resuscitation is not attempted when further therapy is judged inappropriate. Most pediatric deaths involve withdrawal of life support (WDS). Do not resuscitate (DNR) orders remain infrequent in children.
Methods: From a sample of 120 in-patient pediatric deaths at an academic children's hospital, we abstracted demographics, end-of-life care conferences, DNRs, WDS, and time intervals between conferences and death from hospital charts.
Results: Of 63 charts reviewed to date, median age at death was 29 days. Median duration of terminal hospitalization was 10 days. Median time from first care conference to death was 2 days. 95% of deaths occurred in intensive care settings. 11 patients neither WDS nor DNR. 24 patients had written DNRs, while 43 patients had WDS. Of 19 with both DNR and WDS, 16 DNRs were written within 48 hours of WDS. DNRs were more common when patients died >= 2 days versus < 2 days (p=0.01) after the first parent conference. DNR orders did not differ by age at death, length of stay, race, or unit at death, although sample size is still small. Primary diagnoses (oncologic, infectious, prematurity, non-cardiac anomalies, cardiac, respiratory, and CNS conditions) were not correlated with DNR status.
Conclusions: Most pediatric deaths occur in intensive care settings and many patients die receiving maximal care. Almost 50% of patients undergoing WDS have no DNR. DNRs seem an uncommon first step in limiting treatment, written with the expectation of WDS and imminent death. Finally, earlier patient care conferences significantly increased the probability of having DNRs. Given the short interval from poor prognosis to death, we may need to tailor palliative care practices to fit the realities of how and where children die.
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Partridge, J., Baker, B., Sehring, S. et al. 285 Do Not Resuscitate Orders and Withdrawal of Life Support in Dying Pediatric Patients. Pediatr Res 58, 403 (2005). https://doi.org/10.1203/00006450-200508000-00314
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DOI: https://doi.org/10.1203/00006450-200508000-00314
