Child death in the emergency department: experience from a 10-year retrospective review

To describe the demographic characteristics, causes and temporal patterns of child deaths occurring in a paediatric emergency department (ED) over a 10-year period. Single-centre retrospective observational study. A major trauma centre in the UK with a standalone paediatric ED. 58 children aged 0-17 years who died in the ED or were brought in dead between January 2014 and December 2023. None. Causes of death, demographics, seasonal and diurnal variation, parental presence and safeguarding concerns. Median age at death was 2 years. The highest proportion of deaths occurred among infants under 1 year (36%) and adolescents aged 13-17 years (31%). Leading causes of death included sudden unexpected deaths (26%), infections (24%) and acute medical or surgical conditions (16%). Overall mortality was highest during winter months (29%), notably due to infections (50% of infection-related deaths). Sudden unexpected deaths showed clear early morning peaks, with 40% occurring between 04:00 and 07:59. Adolescents (13-17 years) represented 31% of deaths, predominantly due to infections and suicide or self-harm. Parental presence during resuscitation was high (83%). Prior safeguarding concerns were documented in 28% of cases, rising to 100% in deaths due to inflicted injury or abuse. Child deaths in the ED present distinct patterns differing from national childhood mortality statistics, emphasising sudden and acute conditions. Recognising these unique characteristics can guide improvements in clinical practice, ED-specific bereavement support, targeted staff training and resource allocation for periods of highest risk.