End-of-life practices among tertiary care PICUs in the United States: A multicenter study

Kathleen L. Meert*, Linda Keele, Wynne Morrison, Robert A. Berg, Heidi Dalton, Christopher J L Newth, Rick Harrison, David L. Wessel, Thomas Shanley, Joseph Carcillo, Amy Clark, Richard Holubkov, Tammara L. Jenkins, Allan Doctor, J. Michael Dean, Murray Pollack

*Corresponding author for this work

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.

Original languageEnglish (US)
Pages (from-to)e231-e238
JournalPediatric Critical Care Medicine
Volume16
Issue number7
DOIs
StatePublished - Sep 1 2015

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Tertiary Healthcare
Multicenter Studies
Critical Care
Autopsy
Tissue and Organ Procurement
Pediatrics
Length of Stay
Research
Coroners and Medical Examiners
Ethics Committees
Brain Death
Cardiopulmonary Resuscitation
Palliative Care
Pain

Keywords

  • autopsy
  • death
  • end-of-life care
  • organ donation
  • pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Meert, K. L., Keele, L., Morrison, W., Berg, R. A., Dalton, H., Newth, C. J. L., ... Pollack, M. (2015). End-of-life practices among tertiary care PICUs in the United States: A multicenter study. Pediatric Critical Care Medicine, 16(7), e231-e238. https://doi.org/10.1097/PCC.0000000000000520
Meert, Kathleen L. ; Keele, Linda ; Morrison, Wynne ; Berg, Robert A. ; Dalton, Heidi ; Newth, Christopher J L ; Harrison, Rick ; Wessel, David L. ; Shanley, Thomas ; Carcillo, Joseph ; Clark, Amy ; Holubkov, Richard ; Jenkins, Tammara L. ; Doctor, Allan ; Dean, J. Michael ; Pollack, Murray. / End-of-life practices among tertiary care PICUs in the United States : A multicenter study. In: Pediatric Critical Care Medicine. 2015 ; Vol. 16, No. 7. pp. e231-e238.
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abstract = "Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7{\%}; range across sites, 1.3-5.0{\%}) patients died during their hospital stay; of these, 252 (92{\%}; 76-100{\%}) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63{\%}; 47-76{\%}; p = 0.27) who died. Of these, palliative care was consulted for 67 (39{\%}; 12-46{\%}); pain service for 11 (6{\%}; 10 of which were at a single site); and ethics committee for six (3{\%}, from three sites). Mode of death was withdrawal of support for 141 (51{\%}; 42-59{\%}), failed cardiopulmonary resuscitation for 53 (19{\%}; 12-28{\%}), limitation of support for 46 (17{\%}; 7-24{\%}), and brain death for 35 (13{\%}; 8-20{\%}); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37{\%}; 17-88{\%}; p < 0.001). Of these, 20 donated (20{\%}; 0-64{\%}). Sixty-two deaths (23{\%}; 10-53{\%}; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37{\%}; 17-75{\%}; p < 0.001). Of autopsies requested, 53 (67{\%}; 50-100{\%}) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.",
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author = "Meert, {Kathleen L.} and Linda Keele and Wynne Morrison and Berg, {Robert A.} and Heidi Dalton and Newth, {Christopher J L} and Rick Harrison and Wessel, {David L.} and Thomas Shanley and Joseph Carcillo and Amy Clark and Richard Holubkov and Jenkins, {Tammara L.} and Allan Doctor and Dean, {J. Michael} and Murray Pollack",
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Meert, KL, Keele, L, Morrison, W, Berg, RA, Dalton, H, Newth, CJL, Harrison, R, Wessel, DL, Shanley, T, Carcillo, J, Clark, A, Holubkov, R, Jenkins, TL, Doctor, A, Dean, JM & Pollack, M 2015, 'End-of-life practices among tertiary care PICUs in the United States: A multicenter study', Pediatric Critical Care Medicine, vol. 16, no. 7, pp. e231-e238. https://doi.org/10.1097/PCC.0000000000000520

End-of-life practices among tertiary care PICUs in the United States : A multicenter study. / Meert, Kathleen L.; Keele, Linda; Morrison, Wynne; Berg, Robert A.; Dalton, Heidi; Newth, Christopher J L; Harrison, Rick; Wessel, David L.; Shanley, Thomas; Carcillo, Joseph; Clark, Amy; Holubkov, Richard; Jenkins, Tammara L.; Doctor, Allan; Dean, J. Michael; Pollack, Murray.

In: Pediatric Critical Care Medicine, Vol. 16, No. 7, 01.09.2015, p. e231-e238.

Research output: Contribution to journalArticle

TY - JOUR

T1 - End-of-life practices among tertiary care PICUs in the United States

T2 - A multicenter study

AU - Meert, Kathleen L.

AU - Keele, Linda

AU - Morrison, Wynne

AU - Berg, Robert A.

AU - Dalton, Heidi

AU - Newth, Christopher J L

AU - Harrison, Rick

AU - Wessel, David L.

AU - Shanley, Thomas

AU - Carcillo, Joseph

AU - Clark, Amy

AU - Holubkov, Richard

AU - Jenkins, Tammara L.

AU - Doctor, Allan

AU - Dean, J. Michael

AU - Pollack, Murray

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.

AB - Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.

KW - autopsy

KW - death

KW - end-of-life care

KW - organ donation

KW - pediatrics

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