Factors associated with death in the emergency department among children dying of complex chronic conditions: population-based study.
OBJECTIVE
To 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.


METHODS
The 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.


RESULTS
Among 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.


CONCLUSIONS
EDs 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.
Guertin
Marie-Hélène
MH
Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
Côté-Brisson
Linda
L
Major
Diane
D
Brisson
Jacques
J
D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends*; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult