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Pediatric death certification
1Department of Pediatrics, University of Arizona College of Medicine and Steele Memorial Children's Research Center, Tucson, USA.
Insights
Most child deaths are certified by medical examiners or neonatologists, not general pediatricians. Education on pediatric end-of-life care should target specialists most involved in critical events.
Area of Science:
- Pediatric Mortality Analysis
- Death Certification Practices
- Public Health Surveillance
Background:
- Understanding the patterns of pediatric death certification is crucial for improving end-of-life care and support services.
- Previous studies have not comprehensively detailed the physician certifiers, locations, and causes of death for children.
Purpose of the Study:
- To identify the physician certifiers, the locations of death, and the manner of death for all pediatric fatalities.
- To analyze the specialty of physicians certifying pediatric deaths and the circumstances surrounding these deaths.
Main Methods:
- A descriptive study analyzing death certificate data for all children aged 0-17 years.
- Data collected from an urban county covering the years 1995 and 1996.
- Key metrics included physician certifier's specialty, location of death, and cause of death categorization.
Main Results:
- The medical examiner certified 42.6% of 361 child deaths, followed by neonatologists (24.1%) and obstetricians (10.0%).
- Trauma (64.5%) and sudden infant death syndrome (13.5%) were leading causes certified by medical examiners.
- Most deaths occurred in hospitals, but 10.0% occurred at home and 4.4% on roads.
Conclusions:
- General pediatricians are rarely the primary certifiers of pediatric deaths.
- Specialized pediatric critical care and neonatology training should incorporate end-of-life care education.
- Community-based support services are essential for families experiencing child loss.
Objective:
To determine location, manner, and physician certifier of pediatric deaths.
Design:
A descriptive study of death certificate information for all child deaths (aged birth through 17 years) for the years 1995 and 1996.
Setting:
Urban county of more than 780,000 population.
Main Outcome Measures:
Field of specialty of physician certifiers, location of death, and category of deaths certified by the medical examiner.
Results:
Of 361 child deaths, 42.6% were certified by the medical examiner, 24.1% by neonatologists, 10.0% by obstetricians, 8.0% by pediatric critical care specialists, and 5.3% by general pediatricians. The remaining deaths were certified by pediatric subspecialists, surgeons, family practitioners, emergency medicine specialists, hospital pathologists, and law enforcement officials. The medical examiner certified deaths due to trauma (64.5%), sudden infant death syndrome (13.5%), unexplained or suspicious causes (9.7%), medical or surgical complications (3.9%), or because no other physician certifier was available (5.8%). Most children were pronounced dead at hospitals, but 10.0% died at home, 4.4% on roads, and 2.5% on public or private lands.
Conclusions:
General pediatricians are unlikely to be directly involved in the care of most children who die and are therefore unlikely to sign the death certificate. Education about death and dying issues should be available for all pediatricians but should be directed at those specialists most likely to provide care during critical events. Support services for families need to be community based and accessible to survivors.