Abstract P3033: Determining Decision Thresholds For Physicians And Parents For Instituting A Do-Not-Attempt-Resuscitation Order For Pediatric In-Hospital Cardiac Arrest Patients – A Cross-Sectional Study Of Parents And Physicians In The United States

Abstract

Introduction: Decision-making about resuscitating a critically ill child is complex but common. We aimed to study the survival thresholds at which a physician, compared to parents, decides to treat or withhold resuscitating a child. Moreover, we aimed to compare physicians' estimates of survival with the estimates calculated using data from a nationwide registry. Methods: We conducted a cross-sectional survey-based study including parents and physicians in the United States. Clinical vignettes based on hypothetical survival probabilities were used to study and compare the decision thresholds for parents and physicians. Vignettes developed using the Get-With-The-Guidelines-Resuscitation registry were used to explore physicians’ decision thresholds and compare the physician-estimated survival with the survival from the data. Thresholds were determined for each vignette using mixed-effect logistic regression models. Results: A total of 167 parents and 43 physicians provided decisions for 501 and 257 vignettes respectively. The decision threshold for survival to discharge was 5.3% (95% CI: 3.7 to 7.0) for physicians and 1.2% (95% CI: -0.8 to 3.0) for parents. Whereas the decision threshold for survival to discharge with PCPC 1 or 2 was 3.5% (95% CI: 1.1 to 7.1) for physicians and 0.6% (95% CI: -1.2 to 1.8) for parents. Physicians overestimated the likelihood of survival. About 58% estimated a higher survival than that predicted by the multivariate model. The Do-Not-Attempt-Resuscitation threshold based on physician-estimated survival probability was 13% and the threshold based on model-based probability was 5.3%, the same as the one calculated using hypothetical survival probabilities. Conclusions: Using the model-based and hypothetical probability of survival, we estimated the decision threshold for physicians and parents to be 5.3% and 1.2% respectively. This illustrates that parents still want to attempt resuscitation at a survival probability where physicians would recommend withholding the resuscitation. These findings have implications for clinical practice and counseling the parents of critically ill hospitalized children.