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Child death in the emergency department: experience from a 10-year retrospective review
Pamela Jump1,2, Bethany McDermott3, Clarissa Chase1
1Children's Emergency Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
Child deaths in the paediatric emergency department (ED) show distinct patterns, with infants and adolescents most affected by sudden, acute, and infection-related causes. Understanding these trends is crucial for improving care and support.
Area of Science:
- Pediatric Emergency Medicine
- Child Mortality Studies
- Public Health Surveillance
Background:
- Child deaths in emergency departments (EDs) require specific analysis beyond national statistics.
- Understanding temporal and etiological patterns is key to improving pediatric critical care.
Purpose of the Study:
- To characterize demographic, etiological, and temporal patterns of child deaths in a UK pediatric ED over a decade.
- To identify specific risk periods and causes for targeted interventions.
Main Methods:
- Retrospective observational study of 58 children (0-17 years) who died in a standalone pediatric ED (2014-2023).
- Analysis of causes of death, demographics, seasonal/diurnal variations, parental presence, and safeguarding concerns.
Main Results:
- Infants (<1 year) and adolescents (13-17 years) constituted the largest groups of deaths (36% and 31%, respectively).
- Leading causes included sudden unexpected deaths (26%), infections (24%), and acute medical/surgical conditions (16%).
- Mortality peaked in winter (29%), with early morning peaks for sudden unexpected deaths (40% between 04:00-07:59).
- Adolescent deaths were linked to infections and suicide/self-harm; 28% of all cases had prior safeguarding concerns.
Conclusions:
- Pediatric ED deaths exhibit unique patterns, emphasizing sudden and acute conditions, differing from national data.
- Findings can inform clinical practice, bereavement support, staff training, and resource allocation for high-risk periods.
Objective:
To describe the demographic characteristics, causes and temporal patterns of child deaths occurring in a paediatric emergency department (ED) over a 10-year period.
Design:
Single-centre retrospective observational study.
Setting:
A major trauma centre in the UK with a standalone paediatric ED.
Patients:
58 children aged 0-17 years who died in the ED or were brought in dead between January 2014 and December 2023.
Interventions:
None.
Main Outcome Measures:
Causes of death, demographics, seasonal and diurnal variation, parental presence and safeguarding concerns.
Results:
Median age at death was 2 years. The highest proportion of deaths occurred among infants under 1 year (36%) and adolescents aged 13-17 years (31%). Leading causes of death included sudden unexpected deaths (26%), infections (24%) and acute medical or surgical conditions (16%). Overall mortality was highest during winter months (29%), notably due to infections (50% of infection-related deaths). Sudden unexpected deaths showed clear early morning peaks, with 40% occurring between 04:00 and 07:59. Adolescents (13-17 years) represented 31% of deaths, predominantly due to infections and suicide or self-harm. Parental presence during resuscitation was high (83%). Prior safeguarding concerns were documented in 28% of cases, rising to 100% in deaths due to inflicted injury or abuse.
Conclusions:
Child deaths in the ED present distinct patterns differing from national childhood mortality statistics, emphasising sudden and acute conditions. Recognising these unique characteristics can guide improvements in clinical practice, ED-specific bereavement support, targeted staff training and resource allocation for periods of highest risk.
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