Length of Stay by Pediatric Hospice Diagnoses: A Retrospective Experience from a Single Center

Abstract

Context: Pediatric hospice provides care for children during the final stages of a terminal illness, usually defined as a prognosis of six months or less. There is limited data to inform hospice utilization in children among different hospice diagnoses.

Objective: The objective of this study is to perform a retrospective analysis of pediatric hospice patients to better describe clinical trends and utilization among different hospice diagnoses.

Methods: This is a single center retrospective study of pediatric hospice patients enrolled in hospice from 2015-2023 (0-23 y). Using descriptive statistics, the study examines hospice diagnoses, hospice length of stay (LOS), and the type of hospice care, traditional or concurrent care hospice.

Results: One hundred fifty-five pediatric hospice patients met criteria. Children were divided into the four most common diagnostic categories: oncologic (n = 54), neurologic (n = 41), genetic/metabolic (n = 38), and cardiovascular (n = 22). Children who received concurrent care hospice had significantly longer median hospice LOS compared to traditional hospice care (33d vs. 14d; P < 0.001). More than half of the children spent less than one month in hospice (90/155, 58%) with 20% having a late referral defined as hospice LOS ≤ 3 days. There were no statistically significant results between LOS in the four most common diagnostic categories.

Conclusion: Hospice LOS was not statistically different across diagnostic categories. Children enrolled in concurrent care hospice have statistically significant longer stays in hospice compared to traditional hospice. Short hospice stays and late referrals continue to occur.

Keywords: However; On average; There was no significant difference between median hospice LOS between different diagnosis categories; patients with cardiovascular and genetic/metabolic disease had the greatest percentage of hospice enrollments within days before death; pediatric patients enrolled in concurrent care hospice remained alive on hospice longer compared to traditional hospice.