Transferring critically ill babies and children home to die from intensive care

et al. 2020

Preprint

Background: Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data that refer to withdrawing treatment of children in China. Methods: Withdrawing treatment of children in the pediatric intensive care unit (PICU) of a regional children’s hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawing treatment was divided into medical withdrawal and premature withdrawal as defined. The guardian’s self-reported reasons for abandoning the child’s treatment were recorded from 2011.Results: The incidence of withdrawing treatment from children in the PICU decreased significantly, for premature withdrawal, from a 3-year average of 15.1% in 2006–2008 to 1.9% in 2015–2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children from whom treatment was withdrawn increased from 14.5 (interquartile range: 4.0–72.0) months in 2006 to 40.5 (interquartile range: 8.0–99.0) months in 2017. Among the reasons given by guardians of children whose treatments were withdrawn in 2011–2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few of the guardians ascribed withdrawing treatment to economic reasons.Conclusions: The frequency of withdrawal of medical therapy has changed over time in this children’s hospital PICU, and parental decision-making has been a large part of the change.

Section: Discussionsupporting

confidence: 69%

Withdrawal of Treatment in a Pediatric Intensive Care Unit at a Children’s Hospital in China: A 10-year Retrospective Study

Liu¹,

et al. 2020

Preprint

“…This is because some children in our study retained limited maintenance measures (e.g., Ambu) after most of their life-sustaining treatments had been removed to allow them to leave the hospital immediately to let the death occur at home or in their home town. Similar practices can be observed elsewhere: home deaths for critically ill babies/children do occur in the UK, albeit infrequently [38].…”

Section: Discussionsupporting

confidence: 68%

Withdrawal of treatment in a pediatric intensive care unit at a Children’s Hospital in China: a 10-year retrospective study

Liu¹,

et al. 2020

BMC Med Ethics

Background: Published data and practice recommendations on end-of-life care generally reflect Western practice frameworks; there are limited data on withdrawal of treatment for children in China. Methods: Withdrawal of treatment for children in the pediatric intensive care unit (PICU) of a regional children's hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawal of treatment was categorized as medical withdrawal or premature withdrawal. The guardian's self-reported reasons for abandoning the child's treatment were recorded from 2011. Results: The incidence of withdrawal of treatment for children in the PICU decreased significantly; for premature withdrawal the 3-year average of 15.1% in 2006-2008 decreased to 1.9% in 2015-2017 (87.4% reduction). The overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children for whom treatment was withdrawn increased from 14.5 months (interquartile range: 4.0-72.0) in 2006 to 40.5 months (interquartile range: 8.0-99.0) in 2017. Among the reasons given by guardians of children whose treatment was withdrawn in 2011-2017, "illness is too severe" ranked first, accounting for 66.3%, followed by "condition has been improved" (20.9%). Only a few guardians ascribed treatment withdrawal to economic reasons. Conclusions: The frequency of withdrawal of medical therapy has changed over time in this children's hospital PICU, and parental decision-making has been a large part of the change.

“…AMBU) after most of their life-sustaining were removed, and then leave the hospital immediately to let the death happen at home / hometown. Similar practices can be observed elsewhere: home deaths for critically ill babies/children does occur in the UK, although infrequently [34]. When interpreting the results from this study, some limitations should be considered.…”

Section: Discussionsupporting

confidence: 60%

Withdrawal of Treatment in Pediatric Intensive Care Unit at a Children's Hospital of China: a Period of 10 Years Retrospective Study

Liu¹,

et al. 2020

Preprint

Background: Published data and practice recommendations on end-of-life generally reflect Western practice frameworks, there are few reports that refer to withdrawing treatment of children in China. Methods: Withdrawing treatment and reasons of children in the pediatric intensive care unit (PICU) of a regional children's hospital in eastern China from 2006 to 2017 was studied retrospectively. Withdrawing treatment was divided into medical withdrawing and premature withdrawing as defined.Results: The incidence of withdrawing treatment among children in the PICU decreased significantly, for premature withdrawing from a 3-year average of 15.1% in 2006–2008 to 1.9% in 2015–2017 (87.4% reduction). Overall incidence of withdrawal of care reduced over the time period, and withdrawal of therapy by guardians was the main contributor to the overall reduction. The median age of children in whom treatment was withdrawn increased from 14.5 (interquartile range: 4.0-72.0) months in 2006 to 40.5 (interquartile range: 8.0– 99.0) months in 2017. Reasons given by guardians of children whose treatments were withdrawn in 2011-2017, “illness is too severe” ranked first, accounting for 66.3%, followed by “condition has been improved” (20.9%). Only a few of the guardians ascribed withdrawing treatment to economic reasons.Conclusions: The decreasing in incidence of premature withdrawing suggests that guardians are more willing to actively treat their children in this children’s hospital during the last years. Chinese children's guardians have their own unique ways of expression when self-reported reasons for withdrawing treatment.