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- Title
Death and Dying in Hospitalized Pediatric Patients: A Prospective Multicenter, Multinational Study.
- Authors
Nicoll, Jessica; Dryden-Palmer, Karen; Frndova, Helena; Gottesman, Ronald; Gray, Martin; Hunt, Elizabeth A.; Hutchison, James S.; Joffe, Ari R.; Lacroix, Jacques; Middaugh, Kristen; Nadkarni, Vinay; Szadkowski, Leah; Tomlinson, George A.; Wensley, David; Parshuram, Chris S.; Farrell, Catherine
- Abstract
Background: For hospitalized children admitted outside of a critical care unit, the location, mode of death, "do-not-resuscitate" order (DNR) use, and involvement of palliative care teams have not been described across high-income countries. Objective: To describe location of death, patient and terminal care plan characteristics of pediatric inpatient deaths inside and outside the pediatric intensive care unit (PICU). Design: Secondary analysis of inpatient deaths in the Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) randomized controlled trial. Setting/Subjects: Twenty-one centers from Canada, Belgium, the United Kingdom, Ireland, Italy, the Netherlands, and New Zealand. Measurement: Descriptive statistics were used to compare patient and terminal care plan characteristics. A multivariable generalized estimating equation examined if palliative care consult during hospital admission was associated with location of death. Results: A total of 365 of 144,539 patients enrolled in EPOCH died; 219 (60%) died in PICU and 143 (40%) died on another inpatient unit. Compared with other inpatient wards, patients who died in PICU were less likely to be expected to die, have a DNR or palliative care consult. Hospital palliative care consultation was more common in older children and independently associated with a lower adjusted odds (95% confidence interval) of dying in PICU [0.59 (0.52–0.68)]. Conclusion: Most pediatric inpatient deaths occur in PICU where patients were less likely to have a DNR or palliative care consult. Palliative care consultation could be better integrated into end-of-life care for younger children and those dying in PICU.
- Subjects
INTENSIVE care units; RESEARCH; TERMINAL care; PEDIATRICS; MEDICAL cooperation; POPULATION geography; HOSPITAL care of teenagers; MEDICAL protocols; HOSPITAL mortality; DESCRIPTIVE statistics; DEATH; HOSPITAL care of children; LONGITUDINAL method; SECONDARY analysis
- Publication
Journal of Palliative Medicine, 2022, Vol 25, Issue 2, p227
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2021.0205