Evaluation of Paediatric Death Pronouncement from a Resource-Limited Country

Area of Science:

• Pediatric critical care medicine
• Clinical pathology
• Medical ethics

Background:

• Death pronouncement (DP) in pediatric patients presents unique challenges, particularly for junior pediatric residents.
• Accurate and standardized documentation of death pronouncement is crucial for patient care and legal compliance.

Purpose of the Study:

• To evaluate the adherence to World Health Organization (WHO) international criteria for the determination of death in pediatric patients.
• To identify deficiencies in the documentation practices of death pronouncement by pediatric residents.

Main Methods:

• Retrospective chart review of death declaration notes for 165 pediatric patients.
• Analysis of documentation completeness regarding clinical tests (absence of breathing, heartbeat, response to stimuli, ECG findings) and administrative data.
• Assessment of communication note documentation.

Main Results:

• Severe deficiencies were observed in documenting essential clinical tests for death pronouncement.
• Absence of breathing, heartbeat, and response to stimuli were not documented in 74%, 68.5%, and 70.3% of cases, respectively.
• Administrative data were lacking in 31% of cases, and communication notes were almost universally absent (nearly 100% failure).

Conclusions:

• There are critical deficiencies in the current documentation of death pronouncement for pediatric patients.
• Standardized training and adherence to WHO criteria are necessary to improve the quality of death pronouncement practices in pediatric intensive care units.
• Addressing these documentation gaps is essential for improving pediatric end-of-life care and resident education.