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Modes of Death Within a Children's Hospital
Amy Trowbridge1, Jennifer K Walter2,3, Eric McConathey2
1Division of Bioethics and Palliative Care, Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington.
Insights
Most pediatric hospital deaths occur in ICUs, often after withdrawing life-sustaining technology. Palliative care consultation and race may influence how children die in hospitals.
Area of Science:
- Pediatric critical care medicine
- Palliative care
- Healthcare outcomes research
Background:
- Limited knowledge exists on pediatric deaths within hospitals, hindering end-of-life care improvements.
- Understanding the circumstances surrounding pediatric mortality is crucial for enhancing care quality.
Purpose of the Study:
- To analyze the modes and circumstances of death in a pediatric hospital.
- To identify factors associated with different manners of death in children.
Main Methods:
- Retrospective chart review of deceased pediatric patients (July 2011-June 2014).
- Data collected included demographics, diagnoses, length of stay, location of death, and palliative care consultation.
- Qualitative review of clinical notes and resuscitation records to categorize 5 mutually exclusive modes of death.
- Statistical analysis using descriptive statistics and multinomial logistic regression.
Main Results:
- 579 patients died; 61% were infants (<1 year).
- Most deaths occurred in Intensive Care Units (ICUs): Neonatal ICU (29.7%), Pediatric ICU (27.8%), Cardiac ICU (16.6%).
- The most common mode of death was withdrawal of life-sustaining technology (40.2%), followed by nonescalation (25.6%) and failed resuscitation (22.8%).
- Palliative care consultation was associated with a lower likelihood of code deaths (OR 0.31).
- African American patients had a higher likelihood of code deaths compared to white patients (OR 2.46), particularly within 24 hours of admission.
Conclusions:
- Pediatric deaths predominantly occur in ICUs, frequently involving withdrawal of life-sustaining technology.
- Palliative care involvement may reduce the incidence of cardiopulmonary resuscitation (CPR) events leading to death.
- Racial disparities exist in the manner of pediatric death, warranting further investigation.
Abstract:
: media-1vid110.1542/5804909711001PEDS-VA_2017-4182Video Abstract BACKGROUND: Knowledge about how children die in pediatric hospitals is limited, and this hinders improvement in hospital-based end-of-life care.
Methods:
We conducted a retrospective chart review of all the patients who died in a children's hospital between July 2011 and June 2014, collecting demographic and diagnostic information, hospital length of stay, location of death, and palliative care consultation. A qualitative review of provider notes and resuscitation records was used to create 5 mutually exclusive modes of death, which were then assigned to each patient. Analysis included the calculation of descriptive statistics and multinomial logistic regression modeling.
Results:
We identified 579 patients who were deceased; 61% were <1 year of age. The ICU was the most common location of death (NICU 29.7%; PICU 27.8%; cardiac ICU 16.6%). Among the 5 modes of death, the most common was the withdrawal of life-sustaining technology (40.2%), followed by nonescalation (25.6%), failed resuscitation (22.8%), code then withdrawal (6.0%), and death by neurologic criteria (5.3%). After adjustment, patients who received a palliative care consultation were less likely to experience a code death (odds ratio 0.31; 95% confidence interval 0.13-0.75), although African American patients were more likely than white patients to experience a code death (odds ratio 2.46; 95% confidence interval 1.05-5.73), mostly because of code events occurring in the first 24 hours of hospitalization.
Conclusions:
Most deaths in a children's hospital occur in ICUs after the withdrawal of life-sustaining technology. Race and palliative care involvement may influence the manner of a child's death.