Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021

Pediatric deaths often occur within hospitals and involve balancing aggressive treatment with minimization of suffering. This study first investigated associations between clinical/demographic features and the level of intensity of various therapies these patients undergo at the end of life (EOL). S...

Full description

Saved in:

Bibliographic Details
Published in:	Pediatric critical care medicine Vol. 25; no. 10; pp. 899 - 911
Main Authors:	Liesse, Kelly M, Malladi, Lakshmee, Dinh, Tu C, Wesp, Brendan M, Kam, Brittni N, Turturice, Benjamin A, Pyke-Grimm, Kimberly A, Char, Danton S, Hollander, Seth A
Format:	Journal Article
Language:	English
Published:	United States 01-10-2024
Subjects:	Adolescent Adult Child Child, Preschool Cluster Analysis Female Hospital Mortality Humans Infant Infant, Newborn Intensive Care Units, Pediatric - statistics & numerical data Male Palliative Care - statistics & numerical data Retrospective Studies Terminal Care - methods Terminal Care - statistics & numerical data Withholding Treatment - statistics & numerical data Young Adult
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Pediatric deaths often occur within hospitals and involve balancing aggressive treatment with minimization of suffering. This study first investigated associations between clinical/demographic features and the level of intensity of various therapies these patients undergo at the end of life (EOL). Second, the work used these data to develop a new, broader spectrum for classifying pediatric EOL trajectories. Retrospective, single-center study, 2013-2021. Four hundred sixty-one bed tertiary, stand-alone children's hospital with 112 ICU beds. Patients of age 0-26 years old at the time of death. None. Of 1111 included patients, 85.7% died in-hospital. Patients who died outside the hospital were older. Among the 952 in-hospital deaths, most occurred in ICUs (89.5%). Clustering analysis was used to distinguish EOL trajectories based on the presence of intensive therapies and/or an active resuscitation attempt at the EOL. We identified five simplified categories: 1) death during active resuscitation, 2) controlled withdrawal of life-sustaining technology, 3) natural progression to death despite maximal therapy, 4) discontinuation of nonsustaining therapies, and 5) withholding/noninitiation of future therapies. Patients with recent surgical procedures, a history of organ transplantation, or admission to the Cardiovascular ICU had more intense therapies at EOL than those who received palliative care consultations, had known genetic conditions, or were of older age. In this retrospective study of pediatric EOL trajectories based on the intensity of technology and/or resuscitation discontinued at the EOL, we have identified associations between these trajectories and patient characteristics. Further research is needed to investigate the impact of these trajectories on families, patients, and healthcare providers.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1529-7535 1947-3893
DOI:	10.1097/PCC.0000000000003579