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Children 2018, 5(12), 164; https://doi.org/10.3390/children5120164

Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital

1
Division of Pediatric Critical Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA
2
Division of Palliative Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA
*
Author to whom correspondence should be addressed.
Received: 14 November 2018 / Revised: 2 December 2018 / Accepted: 3 December 2018 / Published: 10 December 2018
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Abstract

Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services. Thirty-five percent (167/471) of the patients in our study died with a DNR order in place. Sixty-two percent of patients died in an ICU following DNR order placement. A difference was noted in DNR order timing between patients on general inpatient units and those discharged to home compared with those in the ICUs (p = 0.02). The overall DNR order rate increased following the initiation of the PCT from 30.8% to 39.2% (p = 0.05), but no change was noted in the rate of death in the ICUs. Our study demonstrates a variation in the timing of death following DNR order placement when comparing ICUs and general pediatric floors. Following the initiation of the PCT, we saw increased DNR frequency but no change in the interval between a DNR order and death. View Full-Text
Keywords: cardiopulmonary resuscitation; resuscitation orders/ethics; palliative care/ethics; humans; hospice care; pediatric intensive care units cardiopulmonary resuscitation; resuscitation orders/ethics; palliative care/ethics; humans; hospice care; pediatric intensive care units
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Plymire, C.J.; Miller, E.G.; Frizzola, M. Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital. Children 2018, 5, 164.

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