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Published Online: 31 August 2009

Factors Associated with Death in the Emergency Department among Children Dying of Complex Chronic Conditions: Population-Based Study

Publication: Journal of Palliative Medicine
Volume 12, Issue Number 9

Abstract

Objectives: 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.

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cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 12Issue Number 9September 2009
Pages: 819 - 825
PubMed: 19622014

History

Published in print: September 2009
Published online: 31 August 2009
Published ahead of print: 21 July 2009

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Marie-Hélène Guertin
Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
Linda Côté-Brisson
Service de Soins Palliatifs, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Québec, Canada.
Diane Major
Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
Unité de Recherche en Santé des Populations, Centre Hospitalier Affilié Universitaire de Québec et Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada.
Jacques Brisson
Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
Unité de Recherche en Santé des Populations, Centre Hospitalier Affilié Universitaire de Québec et Département de Médecine Sociale et Préventive, Université Laval, Québec, Canada.

Notes

Address correspondence to:
Jacques Brisson, M.D.
Direction systèmes de soins et politiques publiques
Institut national de santé publique du Québec
945, rue Wolfe, 5e étage
Ste-Foy, Québec G1V 5B3
E-mail: [email protected]

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