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Implications of Pediatric Palliative Consultation for Intensive Care Unit Stay

Zachary M Rossfeld1, Rebecca Miller2, Dmitry Tumin3

  • 11 Palliative Care, OhioHealth Grant Medical Center, Columbus, Ohio.

Journal of Palliative Medicine
|March 6, 2019
PubMed

Insights

Specialty pediatric palliative care (PPC) consultation significantly reduces the daily odds of intensive care unit (ICU) stays for children with serious illnesses. This finding supports the value of PPC in managing complex pediatric cases within the ICU setting.

Area of Science:

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

Background:

  • The impact of pediatric palliative care (PPC) on intensive care unit (ICU) length of stay is not well-established.
  • Understanding how PPC influences ICU utilization is crucial for optimizing care for critically ill children.

Purpose of the Study:

  • To estimate the effect of PPC consultation on ICU length of stay by analyzing ICU days dynamically throughout hospitalization.
  • To quantify the reduction in daily ICU odds following PPC consultation in a pediatric academic hospital.

Main Methods:

  • Retrospective cohort study analyzing 777 admissions (11,954 hospital days) at a children's hospital.
  • Patient-day analysis using multivariable mixed effects logistic regression to predict daily ICU odds.
  • Comparison of ICU odds between admissions with and without PPC consultation.

Main Results:

  • PPC consultation occurred in 13% of admissions (100 out of 777).
  • Daily odds of being in the ICU were significantly reduced post-PPC consultation: by 79% for cancer patients (OR=0.21) and 85% for non-oncologic conditions (OR=0.15).
  • Despite potentially longer total ICU stays, PPC consultation decreased the probability of a child being in the ICU on any given day.

Conclusions:

  • PPC consultation is associated with a substantial decrease in the daily likelihood of ICU utilization for eligible pediatric patients.
  • These findings highlight the value of integrating specialty PPC services to manage complex pediatric conditions and potentially optimize resource use within the ICU.
  • Further research can explore the mechanisms driving this reduction in daily ICU odds.

Keywords:
early palliative carehealth care utilizationpediatric palliative care

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