Characteristics and Outcomes of Patients with Do-not-Resuscitate in Pediatric Intensive Care Unit at King Saud Medical City: A Retrospective Study

Abstract

Background: Do-Not-Resuscitate (DNR) orders in pediatric intensive care units (PICUs) present substantial ethical, medical, and social challenges. This study investigates the factors influencing the issuance of DNR orders and their impact on patient outcomes in a pediatric setting.
Methods: This retrospective cohort study was conducted in the PICU at King Saud Medical City, focusing on pediatric patients aged 1 month to 14 years who were admitted from January 2023 to March 2024 and issued DNR orders during their stay. Data were gathered on demographic and clinical variables, specifics of DNR orders, and patient outcomes.
Results: Out of 150 patients initially assessed, 79 were included in the study. The median age was 12 years (IQR 6-27), with 45.6% male. A significant proportion of the cohort, 59.5% (n=47), received palliative care, whereas 40.5% (n=32) were subjected to treatments deemed futile. The survival analysis revealed a median duration from DNR order issuance to death of 2 days (IQR 1-6). The 12-day survival rate was 47.1% (95% CI 34.7%-64.1%), which remained consistent at 42.8% (95% CI 29.9%-61.4%) for both 36 and 60 days. Brain death was identified as a significant predictor of mortality with a hazard ratio (HR) of 4.68 (95% CI 2.22-9.85) in the multivariate analysis.
Conclusion: The study emphasizes the importance of considering a range of demographic and clinical factors when issuing DNR orders in pediatric patients. It highlights the critical role of palliative care in improving the quality of life, even as ethical dilemmas about futile care persist. Further research is needed to explore the psychosocial impacts of DNR decisions on families and healthcare providers, aiming to refine the approach to end-of-life care in pediatric settings.