Procedural Interventions for Terminally Ill Children - Are We Aiding Palliation?

Area of Science:

• Pediatric Surgery
• Palliative Care
• Healthcare Outcomes

Background:

• Many children with chronic conditions require surgery or invasive procedures during their final hospital admission.
• The specifics of these procedures, patient profiles, and their aims are not well understood.
• Clarifying these details can aid pediatric surgeons in identifying interventions that may not improve palliation or survival.

Purpose of the Study:

• To define the types of procedures, patient demographics, and procedural intent in children with chronic conditions who died during hospitalization.
• To identify factors associated with the number of procedures performed during a terminal hospital admission.

Main Methods:

• Retrospective chart review of pediatric patients (14 days–18 years) with chronic conditions who died inpatient between 2013–2017.
• Data collected included demographics, diagnosis, intubation status, palliative care involvement, and hospital/palliative care duration.
• Negative binomial regression analyzed associations with the total number of procedures.

Main Results:

• 132 children met criteria; most were White, under one year old, with cardiac diagnoses.
• Children had an average of three procedures; 75% were intubated, 77.5% received palliative care.
• Younger age, intubation, and longer hospital stays correlated with more procedures; palliative care involvement correlated with fewer.

Conclusions:

• Children undergo numerous surgical procedures during terminal hospitalizations.
• Factors like age, intubation status, and length of stay significantly influence procedure frequency.
• Further research is needed to determine which procedures offer limited survival benefits for chronically ill children.