• Kelly M Liesse, Lakshmee Malladi, Tu C Dinh, Brendan M Wesp, Brittni N Kam, Benjamin A Turturice, Kimberly A Pyke-Grimm, Danton S Char, and Seth A Hollander.
• Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
• Pediatr Crit Care Me. 2024 Oct 1; 25 (10): 899911899-911.

ObjectivePediatric deaths often occur within hospitals and involve balancing aggressive treatment with minimization of suffering. This study first investigated associations between clinical/demographic features and the level of intensity of various therapies these patients undergo at the end of life (EOL). Second, the work used these data to develop a new, broader spectrum for classifying pediatric EOL trajectories.DesignRetrospective, single-center study, 2013-2021.SettingFour hundred sixty-one bed tertiary, stand-alone children's hospital with 112 ICU beds.PatientsPatients of age 0-26 years old at the time of death.InterventionsNone.Measurements And Main ResultsOf 1111 included patients, 85.7% died in-hospital. Patients who died outside the hospital were older. Among the 952 in-hospital deaths, most occurred in ICUs (89.5%). Clustering analysis was used to distinguish EOL trajectories based on the presence of intensive therapies and/or an active resuscitation attempt at the EOL. We identified five simplified categories: 1) death during active resuscitation, 2) controlled withdrawal of life-sustaining technology, 3) natural progression to death despite maximal therapy, 4) discontinuation of nonsustaining therapies, and 5) withholding/noninitiation of future therapies. Patients with recent surgical procedures, a history of organ transplantation, or admission to the Cardiovascular ICU had more intense therapies at EOL than those who received palliative care consultations, had known genetic conditions, or were of older age.ConclusionsIn this retrospective study of pediatric EOL trajectories based on the intensity of technology and/or resuscitation discontinued at the EOL, we have identified associations between these trajectories and patient characteristics. Further research is needed to investigate the impact of these trajectories on families, patients, and healthcare providers.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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