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

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Tareq Alayed1,2, Waad Al-Sowat1, Abdullah Alturki1

  • 1Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.

Critical Care Research and Practice
|July 21, 2025
PubMed

Insights

Do-not-resuscitate (DNR) orders were placed in 6.4% of pediatric intensive care unit admissions in Saudi Arabia. Patients with DNR orders had significantly higher mortality rates, with 69.2% of deaths occurring in this group.

Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Outcomes Research
  • Medical Ethics

Background:

  • Do-not-resuscitate (DNR) orders are critical in end-of-life care decisions within pediatric intensive care units (PICUs).
  • Understanding the incidence and factors associated with DNR orders is essential for improving care quality and patient outcomes in Saudi Arabia.

Purpose of the Study:

  • To determine the incidence and predictors of DNR orders in a Saudi Arabian PICU.
  • To identify risk factors associated with mortality in PICU patients.

Main Methods:

  • A retrospective cohort study was conducted on 3344 patients admitted to the PICU between January 2021 and December 2023.
  • Data collected included patient demographics, underlying conditions, interventions, DNR status, and mortality.
  • Statistical analysis identified predictors of DNR status and mortality.

Main Results:

  • The incidence of DNR orders was 6.4% among PICU admissions.
  • Mortality was significantly higher in patients with DNR orders (42.3%) compared to those without (1.3%).
  • Predictors of DNR status included male gender, hematological/oncological diseases, cardiovascular diseases, and mechanical ventilation need.

Conclusions:

  • DNR orders were associated with a higher mortality rate in the PICU, accounting for 69.2% of all deaths.
  • Factors such as male gender, specific diseases, and critical interventions influenced DNR order decisions.
  • Further research is needed to explore the nuances of DNR decision-making and its impact on pediatric critical care outcomes.

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