Informed Refusal in Pediatric Practice: a Single Center Experience of a Tertiary Care Children’s Hospital

Abstract

Objective: Informed consent and refusal of medical procedure and treatment are patient rights that are used by parents or legal representatives of children. This study was conducted to determine the most common treatments and medical procedures refused by parents, their distribution according to clinics, and the frequency of reporting the refusal as child medical neglect to governmental and/or judicial authorities. Materials and Methods: In this cross-sectional study, the files in the hospital database of all patients who were admitted to the emergency department, intensive care units, all general pediatrics, pediatric subspecialities and surgery clinics of our hospital between 1 January and 30 June 2019 were retrospectively reviewed. All patients whose medical procedures and treatment were refused during the study period were included in our study. Results: The study group consisted of 348 patients whose medical procedure and treatment were refused by signing an informed refusal form during the study (median age: 1 year 9 months; Male/Female: 197/151). The overall refusal rate was 2.7%. Most of the refusals had occurred in the emergency department. The most common refused recommendation was hospitalization (303/348; 87%), while the most common refused invasive procedure was lumbar puncture (18/39; 46%). There were no cases who refused end-of-life support in the study group, including intensive care units and palliative care units. Only 7.5% of the patients were evaluated as child abuse and neglect, and reported to the governmental/judicial authorities. Conclusion: Discharge against medical advice, which has been reported to increase in recent years, is the most common form of refusal in our study group. Children whose medical procedures and treatment were refused should be carefully evaluated for child abuse and neglect.