• Marie-Hélène Guertin, Linda Côté-Brisson, Diane Major, and Jacques Brisson.
• Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
• J Palliat Med. 2009 Sep 1;12(9):819-25.

ObjectivesTo determine the percentage of deaths occurring or confirmed in an emergency department (ED) among children dying of complex chronic conditions and identify factors associated with that percentage.MethodsThe population and variables of this population-based study were derived from three administrative databases. The study focuses on all children aged 1-19 years who died of complex chronic conditions in Quebec in 1997-2001. Children not hospitalized on seventh day before death were considered at risk of ED death at that time. The percentage of ED deaths was measured in association with year of death, sociodemographic characteristics, outpatient visits, and hospitalizations in the last 6 months of life.ResultsAmong all 506 deaths, 13.8% died in an ED. Among the 300 children not hospitalized on the seventh day before death, 21.7% had an ED death. Compared to children dying from malignancies, the adjusted odds of ED deaths were higher for those with cardiovascular conditions (odds ratio [OR] = 6.3; 95% confidence interval [CI] = 2.3-17.5), metabolic and other congenital or genetic defect (OR = 4.5; 95% CI = 1.5-13.5) and neuromuscular conditions (OR = 3.7; 95% CI = 1.5-9.4). The adjusted odds of ED deaths increased over time and were lower for children with hospitalizations in tertiary pediatric centers (OR = 0.3; 95% CI = 0.1-0.8), compared to those with no hospitalization.ConclusionsEDs play an important role in end-of-life care of children with complex chronic conditions. Multidisciplinary teams of tertiary pediatric centers may be better able to assess prognosis and provide appropriate advanced care planning.

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