title: Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs.
abstract: OBJECTIVE
  Our goal is to assess the prevalence of questioning about the appropriateness of initiating or maintaining life-sustaining treatments (LST) in French-speaking paediatric intensive care units (PICUs) and to evaluate time utilisation related to decision-making processes (DMP).
  
  
  METHODS
  18-month, multicentre, prospective, descriptive, observational study in 15 French-speaking PICUs.
  
  
  RESULTS
  Among the 5,602 children admitted, 410 died (7.3%), including 175 after forgoing LST (42.7% of deaths). LST was questioned in 308 children (5.5%) with a prevalence of 13.3 per 100 patient-days. More than 30% of children survived despite the appropriateness of LST being questioned (23% despite a decision to forgo treatment). Median caregiver time spent on making and presenting the decisions was 11 h per child.
  
  
  CONCLUSIONS
  In this study, on any given day in each 10-bed PICU, there was more than one child for whom a DMP was underway. Of children, 23% survived despite a decision to forgo LST being made, which underlines the need to elaborate a care plan for these children. Also, DMP represented a large amount of staff time that is undervalued but necessary to ensure optimal palliative practice in PICU.
authors.affiliation: Réanimation Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, 59037 Lille Cedex, France. robin.cremer@chru-lille.fr
authors.forename: Robin
authors.initials: R
authors.lastname: Cremer
authors.forename: Philippe
authors.initials: P
authors.lastname: Hubert
authors.forename: Bruno
authors.initials: B
authors.lastname: Grandbastien
authors.forename: Grégoire
authors.initials: G
authors.lastname: Moutel
authors.forename: Francis
authors.initials: F
authors.lastname: Leclerc
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007802:Language; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D016079:Refusal to Treat; D013997:Time Factors