Palliative care discharge from paediatric intensive care units in Great Britain

Abstract

We aim to describe the demographics and clinical characteristics of children discharged to palliative care from 31 paediatric intensive care units in Great Britain, using a cohort of admissions and discharges from the database of paediatric intensive care units (Paediatric Intensive Care Audit Network (PICANet)). The patients included in this study were children discharged alive from paediatric intensive care units (n = 68882) between 1 January 2004 and 31 December 2008. The main outcome measure was Odds Ratios for discharge of children from paediatric intensive care units to palliative care and their referral destination. We found that palliative care status was recorded for 68,090 live discharges from paediatric intensive care units, with 492 (0.7%) discharges to palliative care, a proportion that varied by Strategic Health Authority (range 0 to 1.1). The odds of discharge to palliative care were increased by expected probability of death (log odds of mortality) associated with an oncology, neurology or respiratory diagnosis. South Asian children referred to palliative care were less likely to receive this care in a hospice (OR 0.18, 95% CI 0.04,0.83) and more likely to receive it in a hospital setting (OR 2.57, 95% CI 1.16,5.71). We conclude that children admitted to paediatric intensive care units have a very low rate of discharge to palliative care. Specific demographic and clinical variables are associated with referral to palliative care.