Skip to content


  • Meeting abstract
  • Open Access

A retrospective review of general paediatric inpatient deaths over time

  • Amanda Roth1,
  • Jeremy Friedman2,
  • Adam Rapoport2 and
  • Kim Widger2
BMC Proceedings20159(Suppl 7):A3

Published: 27 October 2015


Care ServicePalliative CareRetrospective ReviewPaediatric Intensive Care UnitData Element


To retrospectively review changes in the circumstances of general paediatric inpatient deaths at a tertiary hospital over three different time periods.


Data was retrospectively collected for all patients who died on the General Paediatric Ward (the Ward) or in the Paediatric Intensive Care Unit (PICU) at this tertiary hospital, in the years 1998, 2005, and 2012. Patients who died in the PICU were considered to have a “general paediatric diagnosis” if their underlying condition or acute diagnosis would have normally resulted in admission to a General Paediatric Ward. The data elements collected were related to: demographic information about the child, health services data, information about provision and orders related to CPR at time of death and the involvement of palliative care services.


85 inpatients met the inclusion criteria; 35 in 1998, 27 in 2005, and 23 in 2012. Differences in location of death were noted across the three time periods. 94.3% of general paediatric patients died in the Paediatric Intensive Care Unit (PICU) in 1998; 59% died in the PICU in 2005, and 69.6% died in the PICU in 2012. The chronological age at which these children died decreased over the three time periods, varying from a median age of death of 5.96 years in 1998, to 4.58 years in 2012. The proportion of patients with ‘no Cardiopulmonary Resuscitation’ (no CPR) orders at the time of death increased over the 14 year period from 31% in 1998 to 87% in 2012. Similarly, the proportion of patients with palliative care involvement increased from 8.6% in 1998 to 73.9% in 2012.


The number of inpatient general paediatric deaths at this tertiary hospital has decreased from 1998 to 2012. A larger proportion of these deaths are occurring on the Wards rather than in the PICU over time. ‘No CPR’ orders and palliative care consultations are becoming more prevalent in these patients prior to death.

Authors’ Affiliations

Royal College of Surgeons in Ireland, Dublin, Ireland
The Hospital for Sick Children, Toronto, Canada


  1. Burns K, Casey P, Lyle R, MacBird T, Fussell J, Robbins J: Increasing Prevalence of Medically Complex Children in US Hospitals. Pediatrics. 2010, 638-646. 126Google Scholar
  2. Simon T, Berry J, Feudtner C, Stone B, Sheng X, Bratton S, Dean JM, Srivastava R: Children with Complex Chronic Conditions in Inpatient Hospital Settings in the United States. Pediatrics. 2010, 647-655. 126Google Scholar
  3. Lindley LC, Lyon L, Lyon ME: A Profile of Children with Complex Chronic Conditions at End of Life among Medicaid Beneficiaries: Implications for Health Care Reform. J Palliat Med. 2013, 1-6. 16Google Scholar
  4. Fraser L, Miller M, Draper E, McKinney P, Parslow R: Place of Death and Palliative Care Following Discharge from Paediatric Intensive Care Units. Arch Dis Child. 2011, 1195-1198. 96Google Scholar
  5. Feudtner C, Christakis D, Zimmerman F, Muldoon John, Koepsell T: Characteristics of Death Occurring in Children's Hospitals: Implications for Supportive Care Services. Pediatrics. 2002, 887-893. 109Google Scholar
  6. Ramanaryan P: Children Continue to Die in Intensive Care. Lancet Oncol. 2007, 455-560. 8Google Scholar
  7. Feudtner C, Feinstein J, Satchell M, Zhao H, Kang T: Shifting Place of Death Among Children with Complex Chronic Conditions in the United States. 1989-2003. JAMA. 2007, 2725-2732. 297Google Scholar
  8. Whitlock JA, Carter BS, Howenstein M, Gilmer MJ, Throop P, France D: Circumstances Surrounding the Deaths of Hospitalized Children: Opportunities for Pediatric Palliative Care. Pediatrics. 2004, 361-366. 114Google Scholar
  9. Harris PA, Taylor R, Thielke R, et al: Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics. 2009, 42 (2): 377-81.PubMedPubMed CentralView ArticleGoogle Scholar


© Roth et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.