(329) The Clinical Impact of Do-Not-Resuscitate Diagnostic Code Usage in Pediatric Patients

Introduction: “Do not resuscitate” (DNR) can be entered as a diagnostic code in the electronic health record (EHR) and may serve as a proxy for DNR orders. The frequency of utilization of this diagnostic code and the clinical aftermath surrounding its use is unknown in children. Our study objectives are to evaluate how often this code is utilized, the subsequent clinical care provided, and the differences between adults and children hypothesizing that children have higher odds of receiving emergency, hospital, and critical care services after DNR diagnostic code entry

Methods: This was a retrospective cohort study using the TriNetX © electronic health record database of pediatric and adult subjects from 53 healthcare organizations who had a DNR diagnostic code entered at any point in their database history and survived at least 30 days from its first entry. We evaluated demographics, the International Classification of Diseases, 9th and 10th edition diagnostic codes, and procedural codes within 1 year from first DNR code entry. The cohort was divided into two groups: (1) pediatrics (aged 0 to 18 years) and (2) adults (aged 18 years and greater).

Results: Of 106,690,302 subjects who had at least one visit encounter in their database history at the time of the query, a total of 359398 subjects [2949 (0.8%) pediatric and 356449 (99.2%) adults] who had a DNR diagnostic code were included in this study. After DNR diagnostic code entry, pediatric subjects had a higher odds of receiving hospital services [1.17 (1.07, 1.28) p = 0.0008], critical care services [2.41 (2.17, 2.68) p< 0.001], and mechanical ventilation [3.94 (3.51, 4.42) p< 0.001]. No association was observed in emergency services [1.05 (0.96, 1.15) p = 0.269].

Conclusions: DNR diagnostic codes are utilized in children. When compared to adults, after utilization, we observed increased odds of hospitalization, critical care services, and mechanical ventilation in pediatric subjects. Future studies are needed to determine if these patients are receiving care that is medically appropriate and in line with a patient’s and/or caregiver’s goals of care.