Withdrawal of Treatment in Pediatric Intensive Care Unit at a Children's Hospital of China: a Period of 10 Years Retrospective Study

Abstract

Background: Published data and practice recommendations on end-of-life generally reflect Western practice frameworks, there are few reports that refer to withdrawing treatment of children in China. Methods: Withdrawing treatment and reasons of children in the pediatric intensive care unit (PICU) of a regional children's hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawing treatment was divided into medical withdrawing and premature withdrawing as defined.Results: The incidence of withdrawing treatment among children in the PICU decreased significantly, for premature withdrawing from a 3-year average of 15.1% in 2006–2008 to 1.9% in 2015–2017 (87.4% reduction). Overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children in whom treatment was withdrawn increased from 14.5 (interquartile range: 4.0-72.0) months in 2006 to 40.5 (interquartile range: 8.0– 99.0) months in 2017. Reasons given by guardians of children whose treatments were withdrawn in 2011-2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few of the guardians ascribed withdrawing treatment to economic reasons.Conclusions: The decreasing in incidence of premature withdrawing suggests that guardians are more willing to actively treat their children in this children’s hospital during the last years. Chinese children's guardians have their own unique ways of expression when self-reported reasons for withdrawing treatment.