Jornal de Pediatria
Print version ISSN 0021-7557
TONELLI, Henrique A.F.; MOTA, Joaquim A.C. and OLIVEIRA, José S.. A profile of the medical conduct preceding child death at a tertiary hospital. J. Pediatr. (Rio J.) [online]. 2005, vol.81, n.2, pp. 118-125. ISSN 0021-7557. http://dx.doi.org/10.1590/S0021-75572005000300006.
OBJECTIVE: To study the profile of care provided to pediatric patients suffering fatal outcomes at a university hospital, including: description of models, comparisons between units, associated factors, participants involved and records of decisions made. METHODS: Cross-sectional study. One of the investigators reviewed the medical and nursing records of deceased patients. Interviews were held and questionnaires filled out with the care team members over a period of 12 months (May 1, 2002 to April 30, 2003). RESULTS: The study included 106 cases. The most frequent treatment patterns at the hospital were: withholding advanced life support (51.9%) and unsuccessful cardiopulmonary resuscitation (44.3%). The decision to make a do-not-resuscitate order occurred later in the intensive care unit (p < 0.05). The restricted care category was more prevalent in the neonatal unit and among patients with chronic diseases that limit survival (p < 0.05). The professionals that most often participated in the decision-making process were the unit's treating physician and resident (52.8%) and the medical team (31.1%). Parents or guardians were observed to have been involved in 20.8% of cases. For the entire hospital, seven cases (6.6%) of ambiguous or discordant cardiopulmonary resuscitation procedures were found. CONCLUSIONS: Procedures involving limitation of therapy are frequent, especially in the neonatal unit. Diagnosis of brain death and withdrawal of advanced life support are, nevertheless, rare. Decisions to grant do-not-resuscitate orders are generally mate late, especially in the intensive care unit. In this sample procedures for full participation in decisions and for recording decisions were imperfect.
Keywords : Terminal care [standards]; resuscitation orders; withholding treatment; professional-family relations [ethics]; death; inpatients.