Pediatrics international : official journal of the Japan Pediatric Society · 2026
End-of-Life Care Patterns by Disease Trajectory in Pediatric Intensive Care Units: A Multicenter Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Jeon Yonghyuk, Jung Chunggang, Jeong Dawoon, An Joosun, Kim You Sun, Jang Wonjin, Lee In Kyung, Lee Bongjin, Park June Dong
Аннотация
BACKGROUND: Delays in end-of-life (EOL) decisions and prolonged life-sustaining treatments (LST) are common in pediatric intensive care units (PICUs), but the influence of underlying disease on EOL decision-making remains unclear. We compared EOL decision patterns and LST practices between oncology and non-oncology patients in PICUs.
METHODS: This retrospective study was conducted at two tertiary PICUs in Seoul, Korea (March 2023-February 2025 at one center; March 2024-February 2025 at the other). Inclusion criteria were patients (0-25 years) admitted to the PICU with a documented EOL decision.
RESULTS: Among 55 patients, 23 were oncology and 32 were non-oncology. Non-oncology patients were younger (median 4.8 vs. 10.8 years, p = 0.040), had more pre-PICU CPR (p = 0.004), and higher Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores (p = 0.001). Time from PICU admission to EOL decision (15.5 vs. 5.0 days, p = 0.034) was longer in non-oncology patients. Palliative care consultation at EOL decision was more frequent among non-oncology patients (78.1% vs. 47.8%, p = 0.025). In exploratory multivariable negative binomial regression adjusting for age and PELOD-2, non-oncology status was associated with a longer time from PICU admission to documented EOL decision (IRR 2.13, 95% CI 1.05-4.35). Withdrawal of LST was more common in non-oncology patients (65.6% vs. 26.1%), while no escalation of support was more common in oncology patients (60.9% vs. 31.3%, p = 0.011).
CONCLUSIONS: EOL decision timing and care patterns differed between oncology and non-oncology patients, suggesting disease trajectory may influence EOL decision-making in PICUs.
METHODS: This retrospective study was conducted at two tertiary PICUs in Seoul, Korea (March 2023-February 2025 at one center; March 2024-February 2025 at the other). Inclusion criteria were patients (0-25 years) admitted to the PICU with a documented EOL decision.
RESULTS: Among 55 patients, 23 were oncology and 32 were non-oncology. Non-oncology patients were younger (median 4.8 vs. 10.8 years, p = 0.040), had more pre-PICU CPR (p = 0.004), and higher Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores (p = 0.001). Time from PICU admission to EOL decision (15.5 vs. 5.0 days, p = 0.034) was longer in non-oncology patients. Palliative care consultation at EOL decision was more frequent among non-oncology patients (78.1% vs. 47.8%, p = 0.025). In exploratory multivariable negative binomial regression adjusting for age and PELOD-2, non-oncology status was associated with a longer time from PICU admission to documented EOL decision (IRR 2.13, 95% CI 1.05-4.35). Withdrawal of LST was more common in non-oncology patients (65.6% vs. 26.1%), while no escalation of support was more common in oncology patients (60.9% vs. 31.3%, p = 0.011).
CONCLUSIONS: EOL decision timing and care patterns differed between oncology and non-oncology patients, suggesting disease trajectory may influence EOL decision-making in PICUs.