First name
Ross
Middle name
M
Last name
Hays

Title

Pediatric palliative care patients: a prospective multicenter cohort study.

Year of Publication

2011

Number of Pages

1094-101

Date Published

06/2011

ISSN Number

1098-4275

Abstract

<p><strong>OBJECTIVE: </strong>To describe demographic and clinical characteristics and outcomes of patients who received hospital-based pediatric palliative care (PPC) consultations.</p>

<p><strong>DESIGN, SETTING, AND PATIENTS: </strong>Prospective observational cohort study of all patients served by 6 hospital-based PPC teams in the United States and Canada from January to March 2008.</p>

<p><strong>RESULTS: </strong>There were 515 new (35.7%) or established (64.3%) patients who received care from the 6 programs during the 3-month enrollment interval. Of these, 54.0% were male, and 69.5% were identified as white and 8.1% as Hispanic. Patient age ranged from less than one month (4.7%) to 19 years or older (15.5%). Of the patients, 60.4% lived with both parents, and 72.6% had siblings. The predominant primary clinical conditions were genetic/congenital (40.8%), neuromuscular (39.2%), cancer (19.8%), respiratory (12.8%), and gastrointestinal (10.7%). Most patients had chronic use of some form of medical technology, with gastrostomy tubes (48.5%) being the most common. At the time of consultation, 47.2% of the patients had cognitive impairment; 30.9% of the cohort experienced pain. Patients were receiving many medications (mean: 9.1). During the 12-month follow-up, 30.3% of the cohort died; the median time from consult to death was 107 days. Patients who died within 30 days of cohort entry were more likely to be infants and have cancer or cardiovascular conditions.</p>

<p><strong>CONCLUSIONS: </strong>PPC teams currently serve a diverse cohort of children and young adults with life-threatening conditions. In contrast to the reported experience of adult-oriented palliative care teams, most PPC patients are alive for more than a year after initiating PPC.</p>

DOI

10.1542/peds.2010-3225

Alternate Title

Pediatrics

PMID

21555495

Title

Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.

Year of Publication

2005

Number of Pages

8

Date Published

2005

ISSN Number

1471-2431

Abstract

<p><strong>BACKGROUND: </strong>Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.</p>

<p><strong>METHODS: </strong>Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.</p>

<p><strong>RESULTS: </strong>Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0-13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.</p>

<p><strong>CONCLUSION: </strong>Technology-dependency is common among children discharged from a children's hospital.</p>

DOI

10.1186/1471-2431-5-8

Alternate Title

BMC Pediatr

PMID

15882452

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