{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:10:27Z","timestamp":1768227027571,"version":"3.49.0"},"reference-count":9,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T00:00:00Z","timestamp":1768089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Objective\u2014Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges. Design\u2014A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility. Results\u2014Partial DNR orders represented a small (n = 15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations. Conclusions\u2014Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. Clinical implications are reviewed. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency.<\/jats:p>","DOI":"10.3390\/children13010106","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:30:34Z","timestamp":1768203034000},"page":"106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Partial Codes Risk Whole Confusion: Characteristics and Outcomes of Pediatric Partial Code Orders"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5627-4536","authenticated-orcid":false,"given":"Rachel","family":"Jalfon","sequence":"first","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"},{"name":"Department of Palliative Care, University of Tennessee Health Science Center, Memphis, TN 38163, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-6530","authenticated-orcid":false,"given":"Brittany","family":"Cowfer","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shankari","family":"Kalyanasundaram","sequence":"additional","affiliation":[{"name":"Analytic Services, Information Services, St Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3206-5648","authenticated-orcid":false,"given":"Deena R.","family":"Levine","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4408-2936","authenticated-orcid":false,"given":"Griffin","family":"Collins","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6522-3876","authenticated-orcid":false,"given":"Erica C.","family":"Kaye","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7124-979X","authenticated-orcid":false,"given":"Liza-Marie","family":"Johnson","sequence":"additional","affiliation":[{"name":"Bioethics Program, St. Jude Children\u2019s Research Hospital Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Ray","family":"Morrison","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish","family":"Pagare","sequence":"additional","affiliation":[{"name":"Analytic Services, Information Services, St Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meaghann S.","family":"Weaver","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Department of Oncology, St. Jude Children\u2019s Research Hospital, Memphis, TN 38105, USA"},{"name":"Bioethics Program, St. Jude Children\u2019s Research Hospital Memphis, TN 38105, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2022058931","DOI":"10.1542\/peds.2022-058931","article-title":"Resuscitate but not Intubate? Partial Codes in Pediatrics","volume":"152","author":"Silverman","year":"2023","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/S0097-5990(16)30179-8","article-title":"Limited cardiopulmonary resuscitation: The ethics of partial codes","volume":"14","author":"Ross","year":"1988","journal-title":"QRB Qual. Rev. Bull."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1001\/jamainternmed.2016.2540","article-title":"Partial Codes\u2014A Symptom of a Larger Problem","volume":"176","author":"Zapata","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1378\/chest.10-1798","article-title":"Code status orders and goals of care in the medical ICU","volume":"139","author":"Gehlbach","year":"2011","journal-title":"Chest"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.jacc.2021.06.042","article-title":"Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest","volume":"78","author":"Naim","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S424","DOI":"10.1161\/CIR.0000000000001370","article-title":"Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Joyner","year":"2025","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.chest.2021.05.044","article-title":"Resuscitation \u00e0 la Carte: Ethical Concerns About the Practice and Theory of Partial Codes","volume":"160","author":"Gremmels","year":"2021","journal-title":"Chest"},{"key":"ref_8","first-page":"e6048","article-title":"Characteristics and Outcomes of Patients with Partial Do Not Resuscitate Orders in a Large Community Hospital","volume":"11","author":"Rafiq","year":"2019","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S719","DOI":"10.1161\/CIR.0000000000001374","article-title":"Part 12: Resuscitation Education Science: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Donoghue","year":"2025","journal-title":"Circulation"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/106\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:52:50Z","timestamp":1768204370000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/1\/106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,11]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["children13010106"],"URL":"https:\/\/doi.org\/10.3390\/children13010106","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,11]]}}}