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Palliative care discharge from paediatric intensive care units in Great Britain

Lorna K Fraser1, Thomas Fleming, Michael Miller

  • 1Paediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, UK.

Palliative Medicine
|March 18, 2010
PubMed

Insights

Only 0.7% of children discharged from pediatric intensive care units (PICUs) received palliative care. Oncology, neurology, and respiratory diagnoses increased odds of palliative care discharge, with South Asian children more likely to receive it in hospitals.

Area of Science:

  • Pediatric critical care medicine
  • Palliative care
  • Health services research

Background:

  • Discharge to palliative care from pediatric intensive care units (PICUs) is infrequent.
  • Understanding demographics and clinical factors influencing this pathway is crucial for improving end-of-life care for critically ill children.

Purpose of the Study:

  • To describe the demographics and clinical characteristics of children discharged to palliative care from PICUs in Great Britain.
  • To identify factors associated with discharge to palliative care and referral destinations.

Main Methods:

  • Retrospective cohort study using data from the Paediatric Intensive Care Audit Network (PICANet) in Great Britain.
  • Analysis of live discharges (n=68,882) from 31 PICUs between January 2004 and December 2008.
  • Calculation of Odds Ratios (OR) for discharge to palliative care and referral destination.

Main Results:

  • Palliative care status was recorded for 68,090 live discharges, with 492 (0.7%) discharged to palliative care.
  • The proportion of discharges to palliative care varied by Strategic Health Authority (0-1.1%).
  • Increased odds of palliative care discharge were associated with oncology, neurology, or respiratory diagnoses.
  • South Asian children were less likely to receive palliative care in hospices (OR 0.18) and more likely in hospitals (OR 2.57).

Conclusions:

  • Children admitted to PICUs have a very low rate of discharge to palliative care.
  • Specific demographic and clinical variables are associated with palliative care referral.
  • Disparities in palliative care access exist, with implications for equitable care delivery.

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