We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
The impact of polysomnograms and family-centred decision making in children with medical complexity.
- Authors
Jewitt, Natalie; Orkin, Julia; Cohen, Eyal; Narang, Indra; Al-Saleh, Suhail; Amin, Reshma
- Abstract
Objectives To determine whether a change in clinical management (e.g. new tracheostomy or adenotonsillectomy) occurred following a polysomnogram (PSG) in children with medical complexity (CMC) and to explore whether families' goals of care (regarding results and treatment implications) were discussed prior to the completion of a PSG. Methods All CMC enrolled in a complex care program at the Hospital for Sick Children, Canada, who underwent a baseline PSG from 2009 to 2015 were identified. Exclusion criteria included (1) PSGs for ventilation titration and (2) PSGs outside the study time frame. Health records were retrospectively reviewed to determine demographics, medical histories, families' wishes, PSG results, and their impact on clinical care. Descriptive statistics were used to summarize results. Results Of 145 patients identified, 96 patients met inclusion criteria. Fifty (52%) were male. Median age was 3 years. Forty-eight (50%) were diagnosed with clinically significant (i.e. moderate to severe obstructive sleep apnea, central sleep apnea, and/or hypoventilation) sleep-related breathing disorders. Of those diagnosed, 9 (19%) had surgery, 25 (52%) underwent respiratory technology initiation, and 3 (6%) underwent both. In the remaining 11 (23%) patients, treatment was either considered too risky or did not align with the families' wishes. Only 3 of 96 patients had clear documentation of their families' wishes prior to PSG completion. Conclusion Recognizing the burden of medical tests for both the child and the health care system, a process of shared-decision making that includes clarifying a family's wishes may be prudent prior to conducting a PSG.
- Subjects
CANADA; TRACHEOTOMY; ACQUISITION of data methodology; FAMILY medicine; MECHANICAL ventilators; ADENOIDECTOMY; CHRONIC diseases in children; POLYSOMNOGRAPHY; RETROSPECTIVE studies; DOCUMENTATION; HYPOVENTILATION; DECISION making; MEDICAL records; COMMUNICATION; DESCRIPTIVE statistics; TONSILLECTOMY; SLEEP apnea syndromes
- Publication
Paediatrics & Child Health (1205-7088), 2021, Vol 26, Issue 2, p114
- ISSN
1205-7088
- Publication type
Article
- DOI
10.1093/pch/pxaa021