Aims: Studying the changing circumstances of inpatient paediatric deaths can support resource allocation, staff training, and palliative care development. This study aims to describe the location, mode of death and the use of palliative care and advanced care planning (ACP) among children who died at KK Women's and Children's Hospital (KKH), Singapore between 2011 to 2020. Method: Medical records of all children who died in the general ward, high dependency unit and paediatric intensive care unit (PICU) were reviewed. Data collected included: demographics, diagnosis, cause, location, mode of death, and the use of palliative care and ACP. Trends were analysed using Mann-Kendall's test and compared using logistic regression. A p-value of less than 0.05 was considered statistically significant. Results: Amongst the 326,372 hospital admissions, 412 (0.13%) children died. Of these, 270 children (65.5%) had at least one complex chronic condition (CCC). 319 children (77.4%) died in the PICU following non-escalation of care (188/412, 45.6%), with palliative care consultation for 119/412 (28.9%) and ACP use for 25/412 (6.1%) patients. Between 2011 to 2020, palliative care consultations increased from 20.4% to 39.3% (p=0.06) and ACP use from 0% to 15.2% (p=0.99). Over the same period, deaths after withdrawal of life sustaining measures (WLSM) increased from 14.3% to 30.3% (p=0.09), while deaths in the general ward decreased from 12.2% to 6.1% (p=0.36). Conclusions: Most hospitalised children died in the PICU following non-escalation of care without palliative care or ACP use. Future research is needed to identify the barriers and facilitators to their use.
Low et al. (Thu,) studied this question.