{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T21:04:29Z","timestamp":1773781469566,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":182,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Critical Care Research and Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    To investigate the incidence and determinants of do\u2010not\u2010resuscitate (DNR) orders, as well as mortality\u2010associated risk factors, in the pediatric intensive care unit (PICU) of a tertiary care center in Saudi Arabia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design:<\/jats:bold>\n                    Retrospective cohort study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting:<\/jats:bold>\n                    The PICU at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Patients:<\/jats:bold>\n                    Patients aged 1\u2009week to 14\u2009years who were admitted to the PICU between January 2021 and December 2023.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Interventions:<\/jats:bold>\n                    None.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Measurements and Main Results:<\/jats:bold>\n                    Of the 3344 patients admitted to the PICU, 53.1% were male; the median age was 3\u2009years (interquartile range: 0\u20138). The most common underlying conditions were neurological in 723 patients (21.6%), hematological\/oncological in 463 (13.9%), and cardiovascular in 417 (12.5%). DNR orders were issued for 6.4% of admissions; among the 213 patients with DNR orders, 24 (11.3%) had a history of resuscitation before the DNR order. The mortality rate was significantly higher among patients with DNR orders (42.3%) compared to those without (1.3%;\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001). Of all 3344 patients, 130 (3.9%) died; of these, 90 (69.2%) had DNR orders. Predictors of DNR status included male gender, hematological\/oncological and cardiovascular diseases, bone marrow transplantation, respiratory distress, sepsis, seizures, bleeding, and need for mechanical ventilation (\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.05).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    This study revealed a DNR order rate of 6.4% among all PICU admissions, with 69.2% of PICU deaths occurring in patients with DNR status. Further analysis is warranted to understand the factors influencing DNR decisions and their impact on patient outcomes.\n                  <\/jats:p>","DOI":"10.1155\/ccrp\/9948312","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T07:18:57Z","timestamp":1751440737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of and Risk Factors for Do\u2010Not\u2010Resuscitate Orders in Critically Ill Children: Insights From a Tertiary Care Center in Saudi Arabia"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7525-3529","authenticated-orcid":false,"given":"Tareq","family":"Alayed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waad","family":"Al-Sowat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Alturki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahad","family":"Aljofan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moath","family":"Alabdulsalam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tariq","family":"Alofisan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raghad","family":"Alhuthil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munirah","family":"Alshalawi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansour","family":"Alghamdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"e_1_2_11_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpem.2007.06.006"},{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(10)60143-2"},{"key":"e_1_2_11_3_2","first-page":"115","article-title":"The Decision of Do Not Resuscitate in Pediatric Practice","volume":"32","author":"Jan M. M.","year":"2011","journal-title":"Saudi Medical Journal"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2008.01353.x"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.45781"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2014.2341"},{"key":"e_1_2_11_7_2","unstructured":"Kingdom Of Saudi ArabiaandSaudi Health Council Policy and Procedure for Do-Not-Resuscitate (DNR) Orders in Saudi Arabia 2017 https:\/\/www.moh.gov.sa\/en\/Ministry\/MediaCenter\/Publications\/Documents\/National-Policy-and-Procedure-for-DNR-Status-EN.pdf."},{"key":"e_1_2_11_8_2","first-page":"561","article-title":"Do Not Resuscitate Orders in a Saudi Pediatric Intensive Care Unit","volume":"35","author":"Al-Ayed T.","year":"2014","journal-title":"Saudi Medical Journal"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.4103\/sjmms.sjmms_141_22"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-019-0355-0"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1590\/1806-9282.65.9.1168"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03460140096034"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.15.1705"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0000000000002312"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2018.06.020"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/5516516"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.112.5.e371"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/08258597211073228"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12212156"},{"key":"e_1_2_11_20_2","volume-title":"Elsevier eBooks","year":"2023"},{"key":"e_1_2_11_21_2","doi-asserted-by":"publisher","DOI":"10.36418\/syntax-literate.v7i2.6244"}],"container-title":["Critical Care Research and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ccrp\/9948312","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/ccrp\/9948312","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/ccrp\/9948312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:41:13Z","timestamp":1773769273000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/ccrp\/9948312"}},"subtitle":[],"editor":[{"given":"Timothy","family":"Plackett","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1155\/ccrp\/9948312"],"URL":"https:\/\/doi.org\/10.1155\/ccrp\/9948312","archive":["Portico"],"relation":{},"ISSN":["2090-1305","2090-1313"],"issn-type":[{"value":"2090-1305","type":"print"},{"value":"2090-1313","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2025-03-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"9948312"}}