131: A Review of General Paediatric Inpatient Deaths Over Time

Abstract

BACKGROUND: Historically, most paediatric deaths have occurred in a hospital setting with up to 85% of these in the Paediatric Intensive Care Unit (PICU). The increase of children with chronic complex conditions (CCC) cared for at paediatric tertiary institutions, who often have shortened- life spans, has also come with an increase in the proportion of deaths at home. Few studies, however, have examined whether the growth of this population has had any effect on deaths within the hospital setting. OBJECTIVES: To describe the changes in in-hospital deaths amongst 'general paediatric' patients at a tertiary care children's hospital in Canada over three different decades. DESIGN/METHODS: Data was collected for all children who died on the general paediatric wards or in the PICU at a children's hospital in Canada in the years 1998, 2005 and 2012. Children who died in the PICU were considered to have a 'general paediatric' diagnosis if their underlying condition or diagnosis would have typically resulted in admission to a general paediatric ward. Data collected was related to: demographics, health services data, cardiopulmonary resuscitation (CPR) status and involvement of palliative care services. Comparisons between different groups were made using χ2 tests or ANOVA with Bonferri correction where appropriate. Institutional ethics review board approval was obtained. RESULTS: 85 children met inclusion criteria; 35 in 1998, 27 in 2005, and 23 in 2012. Differences in location of death were noted across the three time periods. 94% of general paediatric patients died in the PICU in 1998; 59% in 2005, and 70% in 2012 (P=<0.001). The proportion of their lifespan spent as an inpatient increased from 16% to 24% (P=0.61) in this 14-year period. The proportion of patients with 'no CPR' orders at the time of death increased from 31% in 1998 to 87% in 2012 (P=<0.001). Patients with palliative care involvement increased from 8.6% in 1998 to 73.9% in 2012 (P=<0.001). CONCLUSION: The past 14 years has witnessed a reduction in the number of general paediatric inpatient deaths at a children's hospital in Canada. Significant shifts in the characteristics of those children who died in hospital were also seen over this period: a greater proportion of their lives spent as inpatients; increased involvement of palliative care and decisions to not attempt CPR; and ultimately a greater number of deaths on the Paediatric Medicine Ward. These findings may have implications for the provision of quality inpatient end-of-life care for the growing number of children with CCC.