Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care

Division of Critical Care, and.
PEDIATRICS (Impact Factor: 5.47). 06/2013; 132(1). DOI: 10.1542/peds.2013-0470
Source: PubMed

ABSTRACT

Objective:
Comparing demographic and clinical characteristics associated with receipt of palliative care (PC) among children who died in children's hospitals to those who did not receive PC and understanding the trends in PC use.

Methods:
This retrospective cohort study used the Pediatric Health Information System database. Children <18 years of age who died ≥5 days after admission to a Pediatric Health Information System hospital between January 1, 2001, and December 31, 2011 were included. Receipt of PC services was identified by the International Classification of Diseases, Ninth Revision code for PC. Diagnoses were grouped using major diagnostic codes. International Classification of Diseases codes and clinical transaction codes were used to evaluate all interventions.

Results:
This study evaluated 24 342 children. Overall, 4% had coding for PC services. This increased from 1% to 8% over the study years. Increasing age was associated with greater receipt of PC. Children with the PC code had fewer median days in the hospital (17 vs 21), received fewer invasive interventions, and fewer died in the ICU (60% vs 80%). Receipt of PC also varied by major diagnostic codes, with the highest proportion found among children with neurologic disease.

Conclusions:
Most pediatric patients who died in a hospital did not have documented receipt of PC. Children receiving PC are different from those who do not in many ways, including receipt of fewer procedures. Receipt of PC has increased over time; however, it remains low, particularly among neonates and those with circulatory diseases.

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Available from: Susan L Bratton, Oct 27, 2015
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    • "Despite the limited numbers involved, this population engenders high costs for the health services[1,2,7,14], partly as a consequence of the severe comorbidities usually involved[1,3]that make it necessary to involve multiple specialists, services and institutions to provide adequate social support and health care. Like all children with incurable chronic diseases, the ideal place to care for these patients is in their own homes, as unanimously confirmed by the literature151617181920212223. In recent years, technological advances have enabled the use of mechanical ventilation at home, but home care for a child needing mechanical ventilatory support demands the adoption of a highly complex patient care plan7891011121314. "

    Full-text · Article · Jan 2015
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    • "Four of five children with complex chronic conditions in the United States die in the hospital [1]. Among children with cancer 72% of those without PC died in the ICU versus 21% of those with PC [2]. Advance care planning (ACP) is one dimension of palliative care that provides support in decision making about limiting burdensome medical interventions and advance directives . "
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