Death in a paediatric hospital: who, where, and how?

Background: In the developed world, most paediatric deaths follow withdrawal or withholding of medical treatment (WWMT), and previous studies have largely focused on an intensive care setting perspective.

Methods: A retrospective review of medical records was conducted for all paediatric inpatient deaths at the Royal Children’s Hospital (RCH) from April 2015 to April 2016. Results were compared with data from January to June 2007. Chi-squared tests were used for comparisons.

Results: A total of 101 deaths in 2015-2016 were reviewed, and compared to 50 deaths in 2007. In both periods, most deaths followed WWMT (84% vs. 87% of deaths) and occurred in children with pre-existing chronic conditions (84% vs. 85% of deaths). From 2007 to 2015-2016, there was a shift to earlier discussions with parents around WWMT. Cases where discussions began prior to the last admission increased from 4% to 19% (p=0.004). There was also increased palliative care involvement (10% vs. 37%, p<0.001), and more children dying outside of intensive care (16% vs. 22%, p=0.253). In 2015-2016, subgroup analysis revealed that children dying on the wards were 76% more likely to have palliative care involved than those dying in intensive care (p<0.001), and 51% more likely to have discussed WWMT with families before the last admission (p<0.001).

Conclusion: The last decade has seen an increase at RCH in paediatric palliative care involvement and advance discussions around WWMT. These are both associated with death outside of intensive care — a world-first finding that warrants further study.

Conflict of interest

None declared.