Parental Refusal to Lumbar Puncture: Effects on Treatment, Hospital Stay and Leave Against Medical Advice

Ahmed, Mushtaq; Ejaz, Muzamil Shabana; Nasir, Saad; Mainosh, Salma; Jahangeer, Ashraf; Bhatty, M. Akram; Razi, Zobia

doi:10.7759/cureus.7781

Cited by 6 publications

(10 citation statements)

References 11 publications

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“…Parents' age and education status was also significantly associated with consenting rate as parents aged less than 30 years and those without any formal education more frequently refused for LP. This is in contrast to a previously reported study where there was no significant association of age and education with the refusal (13). This may be linked with the awareness of the procedure.…”

Section: Discussioncontrasting

confidence: 99%

“…Regarding provisional diagnosis the LP refusal rate was highest for encephalitis followed by GBS and meningitis, same has been observed by another study where there was higher refusal rate for meningoencephalitis followed by meningitis (13). In parents reasoning for LP refusal, 49% refused because of fear of complications, 29% refused because they thought LP is not needed while 19% preferred their family and 11% preferred some other physician's opinion.…”

Section: Discussionsupporting

confidence: 74%

“…This is in contrast to the study by Acoglu, Esma Altinel et al in which majority of patient's neurological disease had in 45.25% of the patients, central nervous system infection in 45.25%, and acute encephalopathy in 9.5% (20). In contrast to other study where they found meningitis 45-55% patients (13,20).…”

Section: Discussioncontrasting

confidence: 66%

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Lumber Puncture and Associated Factors Among Parents of Children Hospitalized With Suspected Central Nervous System Infectons

Hussain¹,

Anjum²,

Bibi³

et al. 2023

LMRJ

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Lumber Puncture (LP) can be performed for both diagnostic and therapeutic purposes. Failure to perform LP is associated with greater morbidity and mortality due to delayed diagnosis and improper management. This study was conducted to evaluate frequency of LP refusal and its associated factors among parents of children hospitalized with suspected Central Nervous System (CNS) infections. This cross-sectional study was conducted from October 2021 to April 2022 at National Institute of Child Health (NICH), Karachi, Pakistani. Parents/attendants of all pediatric patients hospitalized with suspected CNS infections and advised LP by the treating physicians were included in the study. A semi-structured questionnaire was used to assess the perception and attitude of patients’ towards the procedure and if they agreed for their child to undergo LP. Parents of 338 children were enrolled, out of which 203(60.1%) consented for LP. Majority refused because of fear of complications followed by those who believed LP was not required (29%). Common misconceptions regarding LP complications were risk of death (13%), epilepsy (11%) and paralysis (7%). Significantly lower refusals were observed when no other course was offered as alternate to LP (p-value <0.001). There was high frequency of LP refusal among parents of pediatric patients presenting with suspected CNS infections, most important cause of refusal was fear of complications.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 74%

See 1 more Smart Citation

Lumber Puncture and Associated Factors Among Parents of Children Hospitalized With Suspected Central Nervous System Infectons

Hussain¹,

Anjum²,

Bibi³

et al. 2023

LMRJ

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“…Discharge against medical advice is the most common type of refusal to treatment in this study which was previously reported to increase over the past decade and carry a risk of readmission and have increased morbidity and mortality. Among the invasive interventions, lumbar puncture is the most commonly refused medical intervention in the study group, which is also reported to have a significant effect on the treatment, hospital stay, and disposition outcomes in pediatric settings (34). Most cases of refusal of treatment occur in ED but patients in the pediatric palliative care unit have higher rates of refusal of invasive procedures.…”

Section: Discussionmentioning

confidence: 96%

Informed Refusal in Pediatric Practice: a Single Center Experience of a Tertiary Care Children’s Hospital

Korcum¹,

Bağ²,

Güney³

2021

jchild

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Aydınlatılmış onam ve beraberinde gelen tıbbi işlem ve tedaviyi reddetme hakkı, çocukluk çağında ebeveynler veya yasal temsilciler tarafından kullanılmaktadır. Bu çalışma, çocukluk çağında reddedilen tıbbi işlem ve tedavilerin neler olduğu ve kliniklere göre dağılımı ile ret sonrası çocuk istismarı ve ihmali açısından bildirim sıklığının saptanması amacıyla yürütüldü. Gereç ve Yöntem: Bu kesitsel araştırma, üçüncü basamak olarak hizmet veren ve aynı zamanda eğitim araştırma hastanesi olan bir çocuk hastanesinde yapıldı. Hastanemiz acil servis, yoğun bakım üniteleri, tüm genel pediatri, yan dal ve cerrahi kliniklerinde 1 Ocak-30 Haziran 2019 tarihleri arasında izlenmiş tüm hastaların, hastane veri tabanındaki dosyaları geriye dönük olarak incelendi. Belirtilen çalışma süresi boyunca tıbbi işlem ve tedavi reddi yapılan tüm hastalar çalışmamıza dahil edildi. Bulgular: Çalışma grubu, çalışma süresince tıbbi işlem ve tedavisi, bilgilendirilmiş ret formu imzalanarak reddedilen 348 hastadan oluştu (ortanca yaş: 1 yaş 9 ay; Erkek/Kız: 197/151). Genel ret oranı %2,7 (348/12844) olarak belirlendi. Tıbbi işlem ve reddin en çok oluştuğu birimin acil servis olduğu görüldü. En sık reddedilen durum, hastaneye yatırılarak izlem (303/348; %87), en sık reddedilen girişimsel işlem lomber ponksiyon (18/39; %46) idi. Yoğun bakımlar ve palyatif bakım ünitesi dahil olmak üzere, çalışma grubunda yaşam sonu desteği reddedilen olgu saptanmadı. Hastaların sadece %7,5'i çocuk ihmali olarak değerlendirilerek adli ve idari makamlara bildirilmişti. Sonuç: Son yıllarda giderek arttığı bildirilen, tıbbi öneriye rağmen hastaneden ayrılma, çalışma grubumuzda en sık rastlanan ret şeklidir. Tıbbi işlem ve tedavisi reddedilen çocuklar, çocuk istismarı ve ihmali açısından dikkatli değerlendirilmelidir.

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“…21,22 Studies from Pakistan and Singapore suggest that patients who do not undergo LP are more likely to refuse other medical interventions and to be discharged against medical advice. 23,24 Additional investigation is warranted to investigate this association and the role the patient-HCW relationship plays in these outcomes.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

Elafros

Belessiotis

Birbeck

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Lumbar puncture (LP) is underused for neuroinfectious disease diagnosis in Zambia, but reasons for poor uptake remain speculative. This cross-sectional study assessed LP knowledge, attitudes, and practices among patients/caregivers and healthcare workers (HCWs) and predictors of LP completion. Patients with suspected CNS infection, caregivers, and HCWs at the University Teaching Hospitals in 2016 were eligible. Questions adapted from the existing literature were used for a LP knowledge score. Predictors of knowledge scores were assessed independently for patients/caregivers and HCWs. Predictors of LP completion were assessed using multivariable logistic regression. Among 123 patients/caregivers, LP knowledge was poor. Pediatric caregivers were more likely than adult patients/caregivers to report LP could be replaced by neuroimaging (90% versus 78%, P < 0.001) and cause paralysis (57% versus 39%, P = 0.01). There were no significant predictors of the knowledge score among patients/caregivers. Among HCWs, 28% said LP makes patients clinically worse, and 60% reported it could cause paralysis. The increased knowledge score was associated with greater wealth (P = 0.03) and personally knowing someone who underwent LP (P < 0.001). Lumbar puncture was completed on 67/112 (57%) patients and was associated with an increased knowledge score (OR: 1.62 [95% CI: 1.19–2.23]). Pediatric patients (OR: 0.18 [95% CI: 0.07–0.47]) and those with a fear of paralysis (OR 0.29 [95% CI: 0.11–0.77]) were less likely to undergo LP. Improving LP-related knowledge may improve uptake. Healthcare workers sense of LP risk may also play a role in encouraging/discouraging use.

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Parental Refusal to Lumbar Puncture: Effects on Treatment, Hospital Stay and Leave Against Medical Advice

Cited by 6 publications

References 11 publications

Lumber Puncture and Associated Factors Among Parents of Children Hospitalized With Suspected Central Nervous System Infectons

Lumber Puncture and Associated Factors Among Parents of Children Hospitalized With Suspected Central Nervous System Infectons

Informed Refusal in Pediatric Practice: a Single Center Experience of a Tertiary Care Children’s Hospital

Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

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