J Paediatr Child Health. 2026 Mar 21. doi: 10.1111/jpc.70365. Online ahead of print.
ABSTRACT
AIMS: This study describes the location, mode of death, palliative care and advance care planning (ACP) use amongst children who died at KK Women’s and Children’s Hospital (KKH), Singapore, between 2011 and 2020.
METHODS: Medical records of all children who died in the general ward, high dependency unit and paediatric intensive care unit (PICU) were reviewed. Data collected included: demographics, diagnosis, cause, location, mode of death, palliative care and ACP use. Trends were analysed using the Mann-Kendall test and compared using logistic regression. A p-value of < 0.05 was considered statistically significant.
RESULTS: Amongst 326 372 hospital admissions, 412 children (0.13%) died, of whom 270 (65.5%) had at least one complex chronic condition (CCC). Most deaths occurred in the PICU (319/412, 77.4%), and 188 children (45.6%) died following non-escalation of care. Palliative care consultations were provided in 119 cases (28.9%), and ACP was documented in 25 cases (6.1%). From 2011 to 2020, palliative care consultations increased from 20.4% to 39.3% (p = 0.06) and ACP use increased from 0% to 15.2% (p < 0.05). Over the same period, deaths after withdrawal of life-sustaining measures (WLSM) increased from 14.3% to 30.3% (p = 0.09), whilst deaths in the general ward decreased from 12.2% to 6.1% (p = 0.36).
CONCLUSIONS: Most hospitalised children died in the PICU following non-escalation of care without palliative care or ACP use. Future research is needed to identify the barriers and facilitators to their use.
PMID:41863091 | DOI:10.1111/jpc.70365
