Incidence of and Risk Factors for Do-Not-Resuscitate Orders in Critically Ill Children: Insights From a Tertiary Care Center in Saudi Arabia.

IF 1.8 Q3 CRITICAL CARE MEDICINE
Critical Care Research and Practice Pub Date : 2025-07-02 eCollection Date: 2025-01-01 DOI:10.1155/ccrp/9948312
Tareq Alayed, Waad Al-Sowat, Abdullah Alturki, Fahad Aljofan, Moath Alabdulsalam, Tariq Alofisan, Raghad Alhuthil, Munirah Alshalawi, Mansour Alghamdi
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引用次数: 0

Abstract

Objectives: To investigate the incidence and determinants of do-not-resuscitate (DNR) orders, as well as mortality-associated risk factors, in the pediatric intensive care unit (PICU) of a tertiary care center in Saudi Arabia. Design: Retrospective cohort study. Setting: The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Patients: Patients aged 1 week to 14 years who were admitted to the PICU between January 2021 and December 2023. Interventions: None. Measurements and Main Results: Of the 3344 patients admitted to the PICU, 53.1% were male; the median age was 3 years (interquartile range: 0-8). The most common underlying conditions were neurological in 723 patients (21.6%), hematological/oncological in 463 (13.9%), and cardiovascular in 417 (12.5%). DNR orders were issued for 6.4% of admissions; among the 213 patients with DNR orders, 24 (11.3%) had a history of resuscitation before the DNR order. The mortality rate was significantly higher among patients with DNR orders (42.3%) compared to those without (1.3%; p < 0.001). Of all 3344 patients, 130 (3.9%) died; of these, 90 (69.2%) had DNR orders. Predictors of DNR status included male gender, hematological/oncological and cardiovascular diseases, bone marrow transplantation, respiratory distress, sepsis, seizures, bleeding, and need for mechanical ventilation (p < 0.05). Conclusions: This study revealed a DNR order rate of 6.4% among all PICU admissions, with 69.2% of PICU deaths occurring in patients with DNR status. Further analysis is warranted to understand the factors influencing DNR decisions and their impact on patient outcomes.

危重儿童不复苏命令的发生率和危险因素:来自沙特阿拉伯三级保健中心的见解。
目的:调查沙特阿拉伯某三级医疗中心儿科重症监护病房(PICU)中不复苏(DNR)命令的发生率和决定因素,以及与死亡相关的危险因素。设计:回顾性队列研究。地点:沙特阿拉伯利雅得费萨尔国王专科医院和研究中心的重症监护病房。患者:2021年1月至2023年12月期间入住PICU的1周至14岁患者。干预措施:没有。测量结果及主要结果:在PICU收治的3344例患者中,男性占53.1%;中位年龄为3岁(四分位数范围:0-8岁)。最常见的基础疾病是723例(21.6%)的神经系统疾病,463例(13.9%)的血液/肿瘤疾病,417例(12.5%)的心血管疾病。6.4%的入院者发出了紧急抢救令;213例患者中,24例(11.3%)患者在接受DNR前有复苏史。接受DNR治疗的患者死亡率(42.3%)明显高于未接受DNR治疗的患者(1.3%;P < 0.001)。在所有3344例患者中,130例(3.9%)死亡;其中90例(69.2%)有DNR命令。DNR状态的预测因素包括男性、血液学/肿瘤学和心血管疾病、骨髓移植、呼吸窘迫、败血症、癫痫发作、出血和需要机械通气(p < 0.05)。结论:本研究显示,在所有PICU入院患者中,DNR订单率为6.4%,其中69.2%的PICU死亡发生在处于DNR状态的患者中。有必要进一步分析以了解影响DNR决定的因素及其对患者预后的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Critical Care Research and Practice
Critical Care Research and Practice CRITICAL CARE MEDICINE-
CiteScore
3.60
自引率
0.00%
发文量
34
审稿时长
14 weeks
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