# Procedure and Treatment Refusal in Pediatric Practice: A Single-Center Experience at a Children’s Hospital in Saudi Arabia

## TL;DR

This study examines how often families refuse medical procedures and treatments for children in a Saudi hospital and identifies common reasons for refusal.

## Contribution

The study provides new data on treatment refusal rates and reasons in pediatric patients at a Saudi hospital.

## Key findings

- Nasal swabs were the most commonly refused procedure (28.9%), followed by blood investigations (9.9%).
- Respiratory diseases were the most common diagnosis among children (43.5%).
- Over half of the patients (55.6%) refused some form of medical intervention.

## Abstract

Introduction: Refusal of procedures and treatment for ill children aged up to 14 years old remains a significant issue in the pediatric service. When families refuse medical treatment for their ill children for various reasons, such as financial or transportation difficulties, and concerns about severe side effects, healthcare professionals may attempt to provide information and negotiate with the family about treatment and procedure refusal and its potential consequences, as well as request consent for treatment refusal. In Saudi Arabia, there is a need for more data on treatment refusal.

Objective: We aim to determine the frequency of refusal of medical procedures and treatment in pediatric patients at a children's hospital in Qassim, Saudi Arabia.

Methods: A retrospective review of 1,296 medical records were included. All patients were less than 14 years old. Data were extracted from the hospital's database system. Data analysis was carried out using Statistical Product and Service Solutions (SPSS, version 24; IBM SPSS Statistics for Windows, Armonk, NY).

Results: In a total of 1,296 children attending a children’s hospital in Qassim, Saudi Arabia, we found that the distribution of their age was as follows: 20.8% were one year or less, 30% were two to three years, 23.4% four to six years, and 25.8% were more than six years. The most common reasons for coming to the hospital are that 41% of children came with respiratory symptoms, 18.4% with trauma, and 15% with gastrointestinal symptoms. Respiratory infection/disease was the most commonly reported diagnosis among participants (43.5%), followed by trauma (18.6%) and gastroenteritis (15.3%). Furthermore, we found that (55.6%) refused intervention, while (39.7%) refused observation, 0.7% refused hospitalization, and 0.2% refused examination. A nasal swab was the most commonly refused procedure (28.9%), followed by blood investigations (9.9%) and IV fluids (5.7%).

Conclusion: Refusal of essential medical interventions based on evidence-based practice is still a critical issue in pediatric patients. Identifying the most frequent refused intervention and the reasons beyond intervention refusal is crucial to minimizing the refusal rates.