[A profile of the medical conduct preceding child death at a tertiary hospital].
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.
Tonelli
Henrique A F
HA
Universidade Federal de Minas Gerais, Belo Horizonte, MG. tonelux@uai.com.br
Mota
Joaquim A C
JA
Oliveira
José S
JS
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003643:Death; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care / Q000941:ethics; D008297:Male; D008499:Medical Records; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D013727:Terminal Care / Q000941:ethics; D013997:Time Factors