Publication
What do we know about pediatric palliative care patients who consult the emergency department?
Gaucher N, Humbert N, Gauvin F · Journal of Pain and Symptom Management · 2016
Objective: To determine the characteristics of pediatric palliative care (PPC) patients' emergency department (ED) visits. Methods: This was a five-year retrospective chart review in a tertiary care pediatric university-affiliated hospital. Patients were eligible if their initial consultation with the PPC team occurred between April 1st 2007 and March 31st 2012. For each eligible patient, all ED visits between these dates were included. Each visit's data was drawn from the ED's electronic data system and the patient's medical chart. Results: During the study period, 290 new patients were followed by the PPC team; among them, 94 (32.4%) consulted the ED at least once, for a total of 219 visits. The median number of visits per patient was 2 (range:1-8). Patient median age was 7 years 5 months (range:1 month-22 years) and most common baseline diagnoses were an oncological diagnosis (39.4%), encephalopathy (27.7%) or a genetic/chromosomal anomaly (13.8%). No patients died in the ED, but 36 (38.3%) died during the episode of care following one of their ED visits and 18 (19.1%) of them died within 72h of admission. More than one third (37.9%) of patients arrived by ambulance and 24.2% were admitted to the resuscitation room. Most common reasons for consultation were: respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), fever (9.1%), gastrointestinal symptoms (8.2%), fatigue (7.3%) and technical issues with catheters (5.9%). Most (79%) patients had investigations in the ED. Most (61.2%) patients were admitted to wards, 7.3% were admitted to the PICU and 20.5% were discharged. Majority of patients (65,7%) had a signed advanced care directive at the time of their ED visit. Conclusions: Most PPC patients presented to the ED acutely ill, requiring work-up and admission. Onethird presented in their end of life. Understanding the characteristics of PPC patients' ED visits is the first step in offering better care for these complex patients.
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