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Epidemiology of Inpatient Paediatric Mortalities From 2011 to 2020: A Retrospective Review

Sherry Zhi Qing Low1, Jan Hau Lee2,3, Rehena Sultana1

  • 1Duke-NUS Medical School, Singapore, Singapore.

Journal of Paediatrics and Child Health
|March 21, 2026
PubMed

Insights

Most pediatric deaths in Singapore hospitals occur in the pediatric intensive care unit (PICU) following non-escalation of care. Palliative care and advance care planning (ACP) use increased but remained low, indicating a need for further research.

Area of Science:

  • Pediatric Medicine
  • Palliative Care
  • Healthcare Outcomes

Background:

  • Understanding patterns of death in children is crucial for improving end-of-life care.
  • Advance care planning (ACP) and palliative care are essential components of pediatric end-of-life care.
  • Previous studies have highlighted variations in the utilization of these services.

Purpose of the Study:

  • To describe the location, mode of death, palliative care, and advance care planning (ACP) use among children who died at KK Women's and Children's Hospital (KKH), Singapore.
  • To analyze trends in these factors between 2011 and 2020.
  • To identify potential areas for improvement in pediatric end-of-life care.

Main Methods:

  • Retrospective review of medical records for all children who died in general wards, high dependency units, and pediatric intensive care units (PICUs) between 2011 and 2020.
  • Data collected included demographics, diagnosis, cause of death, location, mode of death, palliative care, and ACP use.
  • Statistical analysis using Mann-Kendall test for trends and logistic regression for comparisons, with p < 0.05 considered significant.

Main Results:

  • Of 412 child deaths, 65.5% had complex chronic conditions. Most deaths occurred in the PICU (77.4%), with 45.6% following non-escalation of care.
  • Palliative care consultations were provided in 28.9% and ACP documented in 6.1% of cases.
  • Palliative care consultations increased from 20.4% to 39.3% (p=0.06) and ACP use from 0% to 15.2% (p<0.05) during the study period.

Conclusions:

  • The majority of hospitalized children died in the PICU, often after non-escalation of care, with limited use of palliative care and ACP.
  • While palliative care and ACP use showed an increasing trend, they remain underutilized.
  • Further research is necessary to determine barriers and facilitators to the optimal implementation of palliative care and ACP in pediatric end-of-life settings.
Abstract

Keywords:
childdeathinpatientspaediatricspalliative care

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