Physicians’ attitudes when faced with life-threatening events in children with severe neurological disabilities

ABSTRACT

Purpose: Children with severe neurological disabilities are at an increased risk of acute, life-threatening events. We assessed physicians’ attitudes when making decisions in these situations.

Methods: We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants’ attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I.

Results: The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues.

Conclusions: Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations.

KEYWORDS:

• Child
• decision making
• disability
• life-threatening events
• physician

Supplemental data for this article can be accessed on the publisher’s website.

Acknowledgments

The authors wish to thank Dr Maria-Helena Perez, Mrs Patricia Fahrni-Nater, Mrs Jeanne-Pascale Simon, and Prof. Lazare Benaroyo for their support during the development of the questionnaire.

Declaration of interest

The authors have no conflicts of interest to declare.