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Alterations in end-of-life support in the pediatric intensive care unit

K Jane Lee1, Kelly Tieves, Matthew C Scanlon

  • 1Medical College of Wisconsin, Department of Pediatrics, 9000 W. Wisconsin Ave, MS B550B, Milwaukee, WI 53226, USA. kjlee@mcw.edu

Pediatrics
|September 8, 2010
PubMed

Insights

Decisions to limit end-of-life support are common in pediatric intensive care units (PICUs). Black race and fewer trainees were linked to less frequent limitation decisions.

Area of Science:

  • Pediatric critical care medicine
  • End-of-life care research
  • Healthcare disparities

Background:

  • End-of-life care decisions significantly impact patient outcomes and family experiences in pediatric intensive care units (PICUs).
  • Understanding variations in end-of-life support is crucial for improving care quality and addressing potential inequities.

Purpose of the Study:

  • To investigate patterns and variations in end-of-life support practices across multiple pediatric intensive care units.
  • To identify demographic and institutional factors associated with decisions to limit life-sustaining treatment.

Main Methods:

  • Retrospective, descriptive study analyzing data from 35 institutions.
  • Collected data included end-of-life support category, patient demographics (race), length of stay, and institutional factors (trainee presence).
  • End-of-life support categories were grouped into 'limitation' and 'no limitation' for analysis, excluding brain death cases.

Main Results:

  • A majority of deaths (85%) involved limitation of support, with significant institutional variation.
  • Decisions to limit support were less frequent in Black patients (76% vs. unspecified for others) and in institutions without trainees (69% vs. unspecified for others).
  • P-values indicate statistically significant differences for race (P=.037) and trainee presence (P<.001).

Conclusions:

  • Limitation of end-of-life support is a prevalent practice in PICUs.
  • Factors such as Black race and the absence of trainees are associated with a lower frequency of limitation decisions.
  • Further research is needed to understand the underlying reasons for these disparities.
Abstract

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