Direction des Systèmes de Soins et Politiques Publiques, Institut National de Santé Publique du Québec, Québec, Canada.
J Palliat Med. 2009 Sep;12(9):819-25. doi: 10.1089/jpm.2009.0041.
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.
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.
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.
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.
确定在急诊科（ED）发生或确认的死亡人数占死于复杂慢性病的儿童的百分比，并确定与该百分比相关的因素。
本基于人群的研究的人群和变量来自三个行政数据库。该研究的重点是 1997-2001 年在魁北克死于复杂慢性病的所有 1-19 岁儿童。在死亡前第七天未住院的儿童被认为当时有在 ED 死亡的风险。ED 死亡的百分比与死亡年份、社会人口统计学特征、门诊就诊和生命最后 6 个月的住院情况相关联。
在所有 506 例死亡中，有 13.8%在 ED 死亡。在 300 名未在死亡前第七天住院的儿童中，有 21.7%的儿童在 ED 死亡。与死于恶性肿瘤的儿童相比，心血管疾病（比值比[OR] = 6.3；95%置信区间[CI] = 2.3-17.5）、代谢和其他先天性或遗传缺陷（OR = 4.5；95% CI = 1.5-13.5）和神经肌肉疾病（OR = 3.7；95% CI = 1.5-9.4）的儿童 ED 死亡的调整比值更高。ED 死亡的调整比值随时间增加，与无住院治疗的儿童相比，在三级儿科中心住院的儿童的比值更低（OR = 0.3；95% CI = 0.1-0.8）。
ED 在患有复杂慢性病的儿童的临终关怀中发挥着重要作用。三级儿科中心的多学科团队可能更有能力评估预后并提供适当的高级护理计划。
