title: Differences in characteristics of dying children who receive and do not receive palliative care.
abstract: OBJECTIVE
  Comparing demographic and clinical characteristics associated with receipt of palliative care (PC) among children who died in children's hospitals to those who did not receive PC and understanding the trends in PC use.
  
  
  METHODS
  This retrospective cohort study used the Pediatric Health Information System database. Children <18 years of age who died ≥5 days after admission to a Pediatric Health Information System hospital between January 1, 2001, and December 31, 2011 were included. Receipt of PC services was identified by the International Classification of Diseases, Ninth Revision code for PC. Diagnoses were grouped using major diagnostic codes. International Classification of Diseases codes and clinical transaction codes were used to evaluate all interventions.
  
  
  RESULTS
  This study evaluated 24 342 children. Overall, 4% had coding for PC services. This increased from 1% to 8% over the study years. Increasing age was associated with greater receipt of PC. Children with the PC code had fewer median days in the hospital (17 vs 21), received fewer invasive interventions, and fewer died in the ICU (60% vs 80%). Receipt of PC also varied by major diagnostic codes, with the highest proportion found among children with neurologic disease.
  
  
  CONCLUSIONS
  Most pediatric patients who died in a hospital did not have documented receipt of PC. Children receiving PC are different from those who do not in many ways, including receipt of fewer procedures. Receipt of PC has increased over time; however, it remains low, particularly among neonates and those with circulatory diseases.
authors.affiliation: Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. linda.keele@hsc.utah.edu
authors.forename: Linda
authors.initials: L
authors.lastname: Keele
authors.forename: Heather T
authors.initials: HT
authors.lastname: Keenan
authors.forename: Joan
authors.initials: J
authors.lastname: Sheetz
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data / Q000639:trends; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: complex chronic conditions; pediatric palliative care