Modes of Death Within a Children’s Hospital

Trowbridge, Amy; Walter, Jennifer K.; McConathey, Eric; Morrison, Wynne; Feudtner, Chris

doi:10.1542/peds.2017-4182

Cited by 91 publications

(72 citation statements)

References 34 publications

(21 reference statements)

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“…A detailed description of these methods, and the 5 modes of death, can be found elsewhere. 12 In brief, each death was categorized as either: 1) Withdrawal of Life Sustaining Technology (WLST): withdrawal of technology within 24 hours of death, 2) Non-Escalation: no resuscitation performed near time of death, no life-sustaining technology withdrawn. Natural death, or hospitalization for EOL care without escalation in therapies, would be included in this mode.…”

Section: Modes Of Deathmentioning

confidence: 99%

“…Of the approximately 45,000 children who die every year, approximately 75% die in a hospital, and of that, approximately 80% die in ICUs. 12,14 Thus, it is not surprising that the majority of resident exposure to EOL care occurs in the ICU setting. A curriculum that prepares residents for EOL care and communication should therefore occur before rotation in ICUs.…”

Section: Location Of Resident Exposure To Deathmentioning

confidence: 99%

“…Previous studies have documented that withholding or withdrawing life-sustaining therapies is the most common mode of death in pediatric ICUs. 12,24 Variable resident exposure to different modes of death has important implications for the educational needs of residents. While ethicists argue that withdrawal and nonescalation are morally equivalent, 25 clinicians note that the cultural, psychological, social, or emotional experience of the 2 modes of death are significantly different.…”

Section: Resident Exposure To Mode Of Deathmentioning

confidence: 99%

“…We did not capture any exposures in the emergency department, where 17 deaths occurred on average per year, most after failed CPR. 12 Residents also spend 2 months at a level III NICU in an affiliated hospital, not included in our data, where an average of 15 deaths per year occurred. Additionally, we did not have a mechanism to count any exposure that may have occurred on electives (particularly for residents who completed a palliative care elective).…”

Section: Limitationsmentioning

confidence: 99%

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Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Trowbridge

Bamat

Griffis

et al. 2020

Academic Pediatrics

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OBJECTIVE: Pediatric residents are expected to be competent in end-of-life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHODS: Retrospective chart review of all deceased patients at one children's hospital over 3 years collected patient demographics, time, and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULTS: Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths); however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of lifesustaining therapy (41%), followed by nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1, <1% of residents encountered a patient death. During PGY-2 and PGY-3, 96% and 78%, respectively, of residents encountered at least 1 death. During PGY-2, residents encountered a mean of 3.5 patient deaths (range 0-12); during PGY-3, residents encountered a mean of 1.4 deaths (range 0-5). Residents observed for their full 3-year residency encountered a mean of 5.6 deaths (range 2-10). CONCLUSIONS: Pediatric residents have limited but variable exposure to EOL care, with most exposures in the ICU after withdrawal of life-sustaining technology. Educators should consider how to optimize EOL education with limited clinical exposure, and design resident support and education with these variable exposures in mind.

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Section: Modes Of Deathmentioning

confidence: 99%

Section: Location Of Resident Exposure To Deathmentioning

confidence: 99%

Section: Resident Exposure To Mode Of Deathmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Trowbridge

Bamat

Griffis

et al. 2020

Academic Pediatrics

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“…Local and international studies validate the finding that the proportion of hospitalized children dying in the ICU is increasing, 12,15,16 with withdrawal of life sustaining technologies being the predominant end-of-life scenario in the developed world. [17][18][19] Critical care providers therefore increasingly need to shift their goals of care to maximize comfort and alleviate suffering. Given access to palliative care may vary significantly in different healthcare settings, intensivists must be adept in the principles and practice of palliative care, underscoring the push to better integrate palliative care in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives

Menon

Mok

Loh

et al. 2019

J Pediatr Intensive Care

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The transfer of critically ill children from intensive care units (ICUs) to their homes for palliation is seldom described. We report our 10-year pediatric palliative transport experience and conducted a survey to gain parents' perspectives of their child's transport experience. Over the study period, eight patients were transported from our pediatric ICU to their homes or hospice facilities. There were no intratransport adverse events. Parents who participated in the survey responded positively to the transport experience. The availability of a dedicated critical care transport service allowed for palliative transfers to be performed safely. Facilitating transport to allow withdrawal of life support at home is an acceptable option to families as part of holistic end-of-life care.

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Polysymptomatology in Pediatric Patients Receiving Palliative Care Based on Parent-Reported Data

et al. 2021

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IMPORTANCE Pediatric palliative care treats patients with a wide variety of advanced illness conditions, often with substantial levels of pain and other symptoms. Clinical and research advancements regarding symptom management for these patients are hampered by the scarcity of data on symptoms as well as an overreliance on clinician report. OBJECTIVE To provide a detailed description of the symptoms among patients receiving pediatric palliative care based on parental report via a validated, structured symptom assessment measure. DESIGN, SETTING, AND PARTICIPANTS Baseline data for this cross-sectional analysis were collected between April 10, 2017, and February 5, 2020, from pediatric palliative care programs in 7 children's hospitals located in Akron

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Modes of Death Within a Children’s Hospital

Abstract: Most deaths in a children's hospital occur in ICUs after the withdrawal of life-sustaining technology. Race and palliative care involvement may influence the manner of a child's death.

Cited by 91 publications

References 34 publications

Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives

Polysymptomatology in Pediatric Patients Receiving Palliative Care Based on Parent-Reported Data

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