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

Dev Neurorehabil. 2019 Jan;22(1):61-66. doi: 10.1080/17518423.2018.1461946. Epub 2018 Apr 12.


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.

MeSH terms

  • Attitude of Health Personnel*
  • Brief, Resolved, Unexplained Event / psychology*
  • Brief, Resolved, Unexplained Event / therapy
  • Child
  • Clinical Decision-Making*
  • Disabled Children
  • Female
  • Humans
  • Infant
  • Male
  • Pediatricians / psychology*
  • Surveys and Questionnaires