Pediatric Unexpected Death: Examination of a Unique Population and Its End-of-Life Care Management (S741)

Abstract

•Describe leading causes and locations of pediatric death in the United States.•Define pediatric sudden unexpected death (SUD).•Compare and contrast differences in demographics, medical therapies, and end-of-life conditions between children dying from unexpected causes with children dying from complications of a chronic disease in the critical care setting. Unintentional injury is the leading cause of death among U.S. children. Although unexpected pediatric death is more common than death from chronic disease, data on end-of-life (EOL) care in this population is scarce. This study aims to describe EOL conditions and practices in children who die in the pediatric intensive care unit (PICU) as a result of sudden, unexpected causes. We performed a chart review of all deaths in a large PICU from 2008 to 2015. Subjects were classified as experiencing sudden unexpected death (SUD) or death related to a life-limiting condition (LLC). Descriptive statistics were used to characterize the cohorts. Wilcoxon test and Fisher’s Exact test were used to compare continuous and categorical variables respectively. Interim analysis revealed 108 deaths in 2008 and 2009 (22% SUD). There were no significant differences in age, gender, or ethnicity. However, children in the SUD group were more likely to have government-only insurance (61%) compared with LLC group (24%) (p < 0.001). Differences in mode of death were not significant, nor were differences in parental presence at death or DNR orders in place prior to death. The SUD group had higher rates of extracorporeal support in the 24 hours prior to death (21%) compared with the LLC group (2%) (p=0.02). Notably, palliative care service consultation was significantly less common (p=0.01) in the SUD group (4.2%) versus the LLC group (28.6%). SUDs are the leading cause of pediatric death in the United States and comprise 22% of deaths in a large PICU. These patients have markers of lower socioeconomic status, and are more likely to use extreme forms of medical care just prior to death.