Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021
Title
Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021
Creator
Liesse KM; Malladi L; Dinh TC; Wesp BM; Kam BN; Turturice BA; Pyke-Grimm KA; Char DS; Hollander SA
Identifier
Publisher
Pediatric Critical Care Medicine
Date
2024
Subject
palliative therapy; major clinical study; retrospective study; cohort analysis; health care personnel; time of death; human; article; child; female; male; terminal care; consultation; resuscitation; intensive care unit; drug therapy; aggression; coronary care unit; special situation for pharmacovigilance; cluster analysis; hospital mortality; organ transplantation
Description
Objective: 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. Design: Retrospective, single-center study, 2013-2021. Setting: Four hundred sixty-one bed tertiary, stand-alone children's hospital with 112 ICU beds. Patients: Patients of age 0-26 years old at the time of death. Interventions: None. Measurements and main results: 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. Conclusions: 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.
Rights
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Citation List Month
September List 2024
URL Address
Collection
Citation
Liesse KM; Malladi L; Dinh TC; Wesp BM; Kam BN; Turturice BA; Pyke-Grimm KA; Char DS; Hollander SA, “Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021,” Pediatric Palliative Care Library, accessed February 17, 2025, https://pedpalascnetlibrary.omeka.net/items/show/19729.