Death and Dying in Hospitalized Pediatric Patients: A Prospective Multicenter, Multinational Study

Area of Science:

• Pediatric critical care medicine
• Palliative care
• End-of-life care research

Background:

• Limited data exists on the location, mode of death, "do-not-resuscitate" (DNR) order use, and palliative care team involvement for hospitalized children outside of critical care units in high-income countries.
• Understanding these factors is crucial for improving end-of-life care in pediatric hospital settings.

Purpose of the Study:

• To describe the location of death and characteristics of patient terminal care plans for pediatric inpatient deaths occurring both inside and outside the pediatric intensive care unit (PICU).
• To examine the association between palliative care consultation and the location of death in hospitalized children.

Main Methods:

• Secondary analysis of data from the Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) randomized controlled trial, involving 21 centers across multiple high-income countries.
• Descriptive statistics were used to compare patient and terminal care plan characteristics. A multivariable generalized estimating equation model assessed the association between palliative care consult and location of death.

Main Results:

• Of 365 pediatric inpatient deaths, 60% occurred in the PICU and 40% on other inpatient units.
• Patients who died in the PICU were less likely to have an expected death, a DNR order, or a palliative care consult compared to those who died on other wards.
• Hospital palliative care consultation was associated with a lower adjusted odds of dying in the PICU and was more common in older children.

Conclusions:

• The majority of pediatric inpatient deaths occur in the PICU, often without documented end-of-life care plans such as DNR orders or palliative care consults.
• Palliative care consultation is independently associated with a lower likelihood of dying in the PICU.
• There is a need to better integrate palliative care consultation into end-of-life care for children, particularly younger children and those dying within the PICU.