Publication
Pediatric Palliative Care Consultation in the PICU Following Out-of-Hospital Cardiac Arrest: Analysis of the U.S. Pediatric Health Information Systems Database, 2013-2023
Gouda S, Snaman J, D'Anna R, Upham E, Dahlberg S, Rosenberg A, DeCourcey D · Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026
Objectives: Subspeciality pediatric palliative care (SPPC) team consultation is an integral component of comprehensive care provided to critically ill children. Little is known about the utilization of SPPC following out-of-hospital cardiac arrest (OHCA) in the United States. Our objectives were to examine SPPC utilization following OHCA and compare characteristics between children who did and did not receive SPPC consultation. Design: Retrospective cohort study. Setting: Forty-seven U.S. children’s hospitals participating in the Pediatric Health Information Systems database. Patients: Children younger than 21 years old with PICU admissions from 2013 to 2023 following OHCA. Interventions: None. Measurements and Main Results: The primary outcome was receipt of SPPC consultation, as identified by International Classification of Diseases codes. Patient characteristics and outcomes were compared between those with and without SPPC consultation. Multiple logistic regression models were fitted to identify factors associated with greater odds of receiving SPPC. Of 1530 pediatric patients hospitalized after OHCA, 198 (13%) received SPPC consultation. SPPC consultation, vs. not, was more common among patients with complex chronic conditions (CCCs; 97% vs. 85%; p < 0.001) and was associated with longer hospital stay (median 4 vs. 2 d; p < 0.001), new medical technology (feeding tube 8.1% vs. 3.8%; p = 0.006 and tracheostomy 8.6% vs. 3.2%; p < 0.001), and in-hospital mortality (82% vs. 66%; p < 0.001). Multivariable analysis suggested the odds (using odds ratio [OR]; 95% CI) of SPPC consultation increased by 21% for each additional CCC (OR, 1.21 [95% CI, 1.11–1.32]) and by 12% annually between 2013 and 2023 (OR, 1.12 [95% CI, 1.06–1.18]). Conclusions: Despite the high morbidity and mortality associated with pediatric OHCA, SPPC consultations were used infrequently and disproportionately concentrated among children with preexisting medical complexity or imminent death. Since all PICU children post-OHCA may benefit from SPPC consultation, future studies should focus on barriers and opportunities for SPPC integration into standard care.
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