P045: What do we know about pediatric palliative care patients who consult the emergency department?

Abstract

Introduction: There is very little data about pediatric palliative care (PPC) patients’ visits to the emergency department (ED). This study’s goal was to determine the characteristics of PPC patients who consult the ED. Methods: A five-year retrospective chart review, conducted at a tertiary care pediatric university-affiliated hospital. Eligible patients initially consulted with the PPC team between April 1^st 2007 and March 31^st 2012. For each eligible patient, ED visits between these dates were included, using the ED’s electronic data system. Data about each visit was drawn from the electronic data system and the patient’s medical chart. This study was IRB approved. Results: During the study period, 290 new patients were followed by the PPC team; of these, 94 (32.4%) consulted the ED at least once (total of 219 visits). The median number of visits per patient was 2 (range: 1-8). Patient median age was 7 years 5 months (range: 1 month-22 years) and most common baseline diagnoses were: oncological diagnosis (39.4%), encephalopathy (27.7%) or genetic/chromosomal anomaly (13.8%). No patients died in the ED, but 36 (38.3%) died during the episode of care following one of their ED visits and 18 (19.1%) of them died within 72h of admission. PPC patients presented to the ED 219 times acutely ill: 11.4% of visits were triaged CTAS (Canadian Triage and Acuity Scale) level 1, 39.3% CTAS 2, 39.3% CTAS 3 and 10% CTAS 4 or 5. Many patients (37.9%) arrived by ambulance, 24.2% were admitted to the resuscitation room. Most patients consulted during day (45.2%) or evening (41.1%) shifts. Median length of stay was 3h50min (range: 13min - 15h10min). Reasons for consultation were respiratory distress/dyspnea (30.6%), pain (12.8%), seizure (11.4%), fever (9.1%), gastrointestinal symptoms (8.2%), fatigue (7.3%) and technical issues with catheters (5.9%). Most (79%) patients had investigations in the ED; 61.2% were admitted to wards, 7.3% to the PICU, and 20.5% were discharged. Two-thirds of patients (65.7%) had previously signed an advanced care directive at the time of their ED visit; discussions about goals of care were present in 37.4% of medical charts. Conclusion: Most PPC patients presented to the ED acutely ill, requiring work-up and admission. One-third presented in their end of life. Understanding the characteristics of PPC patients who consult the ED is the first step in offering better care for these complex patients.