{"title":"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。","authors":"Tareq Alayed, Waad Al-Sowat, Abdullah Alturki, Fahad Aljofan, Moath Alabdulsalam, Tariq Alofisan, Raghad Alhuthil, Munirah Alshalawi, Mansour Alghamdi","doi":"10.1155/ccrp/9948312","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objectives:</b> 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. <b>Design:</b> Retrospective cohort study. <b>Setting:</b> The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. <b>Patients:</b> Patients aged 1 week to 14 years who were admitted to the PICU between January 2021 and December 2023. <b>Interventions:</b> None. <b>Measurements and Main Results:</b> 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%; <i>p</i> < 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 (<i>p</i> < 0.05). <b>Conclusions:</b> 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.</p>","PeriodicalId":46583,"journal":{"name":"Critical Care Research and Practice","volume":"2025 ","pages":"9948312"},"PeriodicalIF":1.8000,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271712/pdf/","citationCount":"0","resultStr":"{\"title\":\"Incidence of and Risk Factors for Do-Not-Resuscitate Orders in Critically Ill Children: Insights From a Tertiary Care Center in Saudi Arabia.\",\"authors\":\"Tareq Alayed, Waad Al-Sowat, Abdullah Alturki, Fahad Aljofan, Moath Alabdulsalam, Tariq Alofisan, Raghad Alhuthil, Munirah Alshalawi, Mansour Alghamdi\",\"doi\":\"10.1155/ccrp/9948312\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objectives:</b> 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. <b>Design:</b> Retrospective cohort study. <b>Setting:</b> The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. <b>Patients:</b> Patients aged 1 week to 14 years who were admitted to the PICU between January 2021 and December 2023. <b>Interventions:</b> None. <b>Measurements and Main Results:</b> 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%; <i>p</i> < 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 (<i>p</i> < 0.05). <b>Conclusions:</b> 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.</p>\",\"PeriodicalId\":46583,\"journal\":{\"name\":\"Critical Care Research and Practice\",\"volume\":\"2025 \",\"pages\":\"9948312\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271712/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Research and Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/ccrp/9948312\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Research and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/ccrp/9948312","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Incidence of and Risk Factors for Do-Not-Resuscitate Orders in Critically Ill Children: Insights From a Tertiary Care Center in Saudi Arabia.
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.