End-of-Life Care Patterns by Disease Trajectory in Pediatric Intensive Care Units: A Multicenter Study

Area of Science:

• Pediatric critical care medicine
• Palliative care
• Oncology

Background:

• End-of-life (EOL) decisions and life-sustaining treatments (LST) are frequent in pediatric intensive care units (PICUs).
• The impact of underlying disease on EOL decision-making processes is not well understood.
• This study investigates differences in EOL decision patterns between pediatric oncology and non-oncology patients.

Purpose of the Study:

• To compare end-of-life (EOL) decision-making timelines and life-sustaining treatment (LST) practices in pediatric oncology versus non-oncology patients within PICUs.
• To identify factors influencing EOL decisions based on disease category.

Main Methods:

• Retrospective study conducted in two tertiary PICUs in Seoul, Korea.
• Inclusion criteria: patients aged 0-25 years admitted to the PICU with a documented EOL decision.
• Data analysis included comparisons of demographics, clinical characteristics, and EOL care patterns between oncology and non-oncology groups.

Main Results:

• Non-oncology patients were younger, had higher initial illness severity (PELOD-2 scores), and required more pre-PICU cardiopulmonary resuscitation (CPR).
• Time from PICU admission to EOL decision was significantly longer for non-oncology patients (15.5 days vs. 5.0 days).
• Withdrawal of LST was more common in non-oncology patients (65.6%), while no escalation of support was more frequent in oncology patients (60.9%). Palliative care consultation was more frequent in non-oncology patients.

Conclusions:

• Disease trajectory significantly influences EOL decision-making timing and care strategies in the PICU.
• Differences in EOL care patterns between oncology and non-oncology patients highlight the need for tailored approaches.
• Further research is warranted to optimize EOL care for diverse pediatric populations in critical care settings.