Investigators from New Zealand and Australia determined the demographic and diagnostic factors associated with the location of death in children with life-limiting disease. They reviewed mortality records of children ages 28 days to 18 years who died in New Zealand during the years 2006 to 2009. Children were identified as having a life-limiting disease if their cause of death matched an ICD-10 code that the investigators considered was reflective of a life-limiting disease for which death could be anticipated and a palliative care (PC) approach beneficial. Demographic features of race, age, and socioeconomic status were abstracted from records. Case records from the only pediatric PC service in New Zealand were searched to verify whether the children who died during the study period were referred for pediatric PC services.
There were 494 children who met inclusion criteria out of the 1,797 children in this age group who died during the study period. Of these, 207(42%) died at home, 265 (54%) died in hospital, and 6 (1%) died in hospice. Factors significantly associated with death in a hospital included race (higher in Asian and Pacific children compared to European; ORs 2.22 and 2.66, respectively). Children were significantly less likely to die in a hospital if they had a malignant condition (OR = 0.48) or were referred to the pediatric PC service (OR = 0.60). Only 106 (21%) children in the analysis were referred for pediatric PC services. Factors associated with PC referral included patient age <1 year and a diagnosis of malignancy.
The authors conclude that children referred for PC services were less likely to die in a hospital.
Dr Keele has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Palliative care has been used to care for adults with life-limiting conditions for many years, but the first programs for children were not started until the late 1990s. Since then, pediatric PC programs have spread throughout the United States and other countries. PC may be beneficial in many ways. For example, it helps families with end-of-life decisions and provides bereavement services, sibling support, and pain/symptom management prior to and at the time of death. A recent study showed that hospitalized children receiving PC at the time they died received fewer invasive interventions (eg, surgery, mechanical ventilation), were less likely to die in an ICU, and had a shorter terminal hospital length of stay.1 The current report adds another benefit of PC. Among children with a life-limiting illness the receipt of PC services was associated with a 40% decreased odds of dying in the hospital.
However, only 21% of the study population received pediatric PC. Efforts to assess pediatric PC need are complicated. According to the American Academy of...