Prevalence of specialised palliative care consultation for eligible children within a paediatric cardiac ICU

Abstract

Objective: Retrospectively apply criteria from Center to Advance Palliative Care to a cohort of children treated in a cardiac ICU and compare children who received a palliative care consultation to those who were eligible for but did not receive one. Methods: Medical records of children admitted to a cardiac ICU between January 2014 and June 2017 were reviewed. Selected criteria include cardiac ICU length of stay >14 days and/or ≥ 3 hospitalisations within a 6-month period. Measurements and Results: A consultation occurred in 17% (n = 48) of 288 eligible children. Children who received a consult had longer cardiac ICU (27 days versus 17 days; p < 0.001) and hospital (91 days versus 35 days; p < 0.001) lengths of stay, more complex chronic conditions at the end of first hospitalisation (3 versus1; p < 0.001) and the end of the study (4 vs.2; p < 0.001), and higher mortality (42% versus 7%; p < 0.001) when compared with the non-consulted group. Of the 142 pre-natally diagnosed children, only one received a pre-natal consult and 23 received it post-natally. Children who received a consultation (n = 48) were almost 2 months of age at the time of the consult. Conclusions: Less than a quarter of eligible children received a consultation. The consultation usually occurred in the context of medical complexity, high risk of mortality, and at an older age, suggesting potential opportunities for more and earlier paediatric palliative care involvement in the cardiac ICU. Screening criteria to identify patients for a consultation may increase the use of palliative care services in the cardiac ICU.

Palliative care referral criteria and application in pediatric illness care: A scoping review

“…Reports cited criteria related to the frequency and length of hospitalizations 29,30,33,37,38,47 or stays in an intensive care unit. 35,37,38,40,47,49,53,56,58 For example, Lutmer 53 described one of their pediatric palliative care screening criteria as a pediatric intensive care stay that lasted more than 2 weeks with a demonstration of multiple system organ failure. Additionally, referral criteria focused on specific populations with planned or unplanned treatment within an acute care facility.…”

“…Twenty-nine (78.4%) articles in this review discussed disease-related criteria in some form. This included the diagnosis of a life-limiting disease, high-risk illness, or complex chronic condition, [35][36][37][38][43][44][45]47,[52][53][54][58][59][60][62][63][64][65] as well as a relapse/recurrence or refractory disease. 40,47,49,54,56,63 The prognosis, 35,36,41,42,54,65 progression of the disease, 29,30,33,40,42,49,47,52,56 and estimates of life-expectancy were also commonly used to initiate pediatric palliative care referrals.…”

“…29,30,33,42,43,51,65 For disease-specific populations, individual diagnoses or complications (e.g., metabolic disease, chromosomal abnormality, premature birth, myocarditis) were evaluated. [36][37][38][39]46,63 Other criteria accounted for comorbidities 37,38,51 or the functional impact on daily activities. 29,30,33 One research study included the risk of a life-threatening event.…”

“…29,30,33,35,36,47 Many articles referenced treatment-specific criteria (e.g., discussion of enrollment in a Phase 1 trial, tracheostomy placement). 32,[35][36][37][38]40,49,56,63,64 Additionally, several articles referenced treatment goals 32,34,47,55,57,61,63 and one article cited ethical considerations. 48 Acute care needs.…”

Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams

“…The American Academy of Pediatrics has previously recommended the development of pediatric palliative care (PPC) services to be an integral part of the multi-disciplinary care of children with terminal or life-threatening conditions [8]. Additionally, PPC is increasingly utilized in the care of critically ill children in the ICU [12][13][14]. Suggested criteria for palliative care involvement include an ICU length of stay longer than 2 weeks, respiratory failure with significant comorbidities, neurologic injury, or other serious or life-limiting conditions [12,13].…”