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Pediatric Palliative Care Consultation in the PICU Following Out-of-Hospital Cardiac Arrest: Analysis of the U.S.
Suzanne R Gouda1,2,3, Jennifer M Snaman2,3,4, Rachel D'Anna5
1Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Insights
Subspeciality pediatric palliative care (SPPC) consultations are infrequently used for children after out-of-hospital cardiac arrest (OHCA). SPPC is more common in medically complex children, despite potential benefits for all.
Area of Science:
- Pediatric critical care medicine
- Palliative care
- Cardiology
Background:
- Subspeciality pediatric palliative care (SPPC) is crucial for critically ill children.
- Utilization of SPPC following pediatric out-of-hospital cardiac arrest (OHCA) in the U.S. is not well understood.
Purpose of the Study:
- To examine the utilization of SPPC services in children following OHCA.
- To compare characteristics of children who received SPPC consultation versus those who did not.
Main Methods:
- Retrospective cohort study involving 47 U.S. children's hospitals.
- Analyzed data of children younger than 21 years admitted to the PICU after OHCA between 2013 and 2023.
- Used International Classification of Diseases codes to identify SPPC consultation.
Main Results:
- Only 13% (198/1530) of pediatric patients after OHCA received SPPC consultation.
- SPPC was more common in children with complex chronic conditions (CCCs) (97% vs. 85%).
- SPPC consultation was associated with longer hospital stays, increased use of medical technology, and higher in-hospital mortality.
Conclusions:
- SPPC consultations are underutilized in pediatric OHCA cases and concentrated in the most medically complex or imminently dying children.
- All pediatric intensive care unit (PICU) patients post-OHCA may benefit from SPPC.
- Future research should explore barriers and opportunities for integrating SPPC into routine care for these patients.
Objectives:
Subspeciality pediatric palliative care (SPPC) team consultation is an integral component of comprehensive care provided to critically ill children. Little is known about the utilization of SPPC following out-of-hospital cardiac arrest (OHCA) in the United States. Our objectives were to examine SPPC utilization following OHCA and compare characteristics between children who did and did not receive SPPC consultation.
Design:
Retrospective cohort study.
Setting:
Forty-seven U.S. children's hospitals participating in the Pediatric Health Information Systems database.
Patients:
Children younger than 21 years old with PICU admissions from 2013 to 2023 following OHCA.
Interventions:
None.
Measurements And Main Results:
The primary outcome was receipt of SPPC consultation, as identified by International Classification of Diseases codes. Patient characteristics and outcomes were compared between those with and without SPPC consultation. Multiple logistic regression models were fitted to identify factors associated with greater odds of receiving SPPC. Of 1530 pediatric patients hospitalized after OHCA, 198 (13%) received SPPC consultation. SPPC consultation, vs. not, was more common among patients with complex chronic conditions (CCCs; 97% vs. 85%; p < 0.001) and was associated with longer hospital stay (median 4 vs. 2 d; p < 0.001), new medical technology (feeding tube 8.1% vs. 3.8%; p = 0.006 and tracheostomy 8.6% vs. 3.2%; p < 0.001), and in-hospital mortality (82% vs. 66%; p < 0.001). Multivariable analysis suggested the odds (using odds ratio [OR]; 95% CI) of SPPC consultation increased by 21% for each additional CCC (OR, 1.21 [95% CI, 1.11-1.32]) and by 12% annually between 2013 and 2023 (OR, 1.12 [95% CI, 1.06-1.18]).
Conclusions:
Despite the high morbidity and mortality associated with pediatric OHCA, SPPC consultations were used infrequently and disproportionately concentrated among children with preexisting medical complexity or imminent death. Since all PICU children post-OHCA may benefit from SPPC consultation, future studies should focus on barriers and opportunities for SPPC integration into standard care.
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