Table 1. Alternatives to prior individual consent in emergency paediatric research.

Type of consent	Characteristics	Critique
Deferred consent	Initial assent to enter the study is obtainedFull informed consent is deferred (delayed) until the patienthas stabilised and/or surrogates areable to listen and understand trial informationSurrogates can withdraw at any point	Consent cannot be obtained after the intervention has already been given; consent is only therefore permission to remain in the study
Proxy consent by third parties	An appropriate person other than the parent/immediate guardiangives consent for the participantPotential proxies include - legal representatives, and independent physicians	Difficulties in ensuring independence of proxiesProxies not capable of knowing the wishes of a parent especially without prior discussion
Advanced consent/Presumed consent:	Potential participants are identified prior to meeting eligibilitycriteria and consent for future enrolment should theybecame eligible	Difficult to identify participants in advance in emergency researchPotentially causes unnecessary distress or harm, especially where inclusion criteria are not met
Retrospective consent	Initial research intervention occurs without the surrogate’s consentConsenting takes place after the initiation or completion ofthe research intervention	Participants have no control over what has been done in the past
Waiver of consent:	Research intervention occurs without the participant’s orsurrogate’s consent	Considered to be a violation of patient autonomy