Dingfield Laura, Bender Laura, Harris Pamela, Newport Kristina, Hoover-Regan Margo, Feudtner Chris, Clifford Sheila, Casarett David
1 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Palliat Med. 2015 Feb;18(2):120-6. doi: 10.1089/jpm.2014.0195. Epub 2014 Nov 20.
Most pediatric hospice patients receive services from agencies typically oriented to adults. Information regarding how pediatric hospice patients differ from adult hospice patients is lacking.
We aim to assess differences between pediatric and adult hospice patients regarding patient characteristics and outcomes.
We compiled a retrospective inception cohort of patients enrolled at nine hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) between August 1, 2008 and June 30, 2012. Measurements included patient characteristics and outcomes, including discharge from hospice and site of death.
Among 126,620 hospice patients, 986 (0.8%) were 18 years of age or younger. Pediatric patients were less likely to have an admitting diagnosis of cancer (odds ratio [OR] 0.62; 95% confidence interval [CI]: 0.54-0.72). Although children were less likely to use oxygen at enrollment (OR 0.31; 95% CI: 0.26-0.37), they were more likely to have an enteral feeding tube (OR 4.04; 95% CI: 3.49-4.67). Pediatric patients were half as likely as adults to have a do-not-resuscitate order (DNR) order upon hospice enrollment (OR 0.52; 95% CI: 0.46-0.59). The average hospice length of stay for pediatric patients was longer than that of adults (103 days versus 66 days, p<0.001). Children were more likely to leave hospice care (OR 2.59; 95% CI: 2.00-3.34), but among patients who died while enrolled in hospice, pediatric patients were more likely to die at home (OR 3.25; 95% CI: 2.27-3.88).
Pediatric hospice patients differ from adult patients in their broader range of underlying diagnoses and their use of hospice services.
大多数儿科临终关怀患者接受的是通常面向成人的机构提供的服务。目前缺乏有关儿科临终关怀患者与成人临终关怀患者差异的信息。
我们旨在评估儿科和成人临终关怀患者在患者特征和结局方面的差异。
我们汇总了2008年8月1日至2012年6月30日期间在CHOICE网络（组织起来调查比较效果的临终关怀联盟）的9家临终关怀机构登记的患者的回顾性起始队列。测量指标包括患者特征和结局，包括临终关怀出院情况和死亡地点。
在126,620名临终关怀患者中，986名（0.8%）年龄在18岁及以下。儿科患者入院诊断为癌症的可能性较小（优势比[OR]0.62；95%置信区间[CI]：0.54 - 0.72）。虽然儿童在入院时使用氧气的可能性较小（OR 0.31；95% CI：0.26 - 0.37），但他们更有可能有肠内喂养管（OR 4.04；95% CI：3.49 - 4.67）。儿科患者在临终关怀入院时下达不进行心肺复苏医嘱（DNR）的可能性是成人的一半（OR 0.52；95% CI：0.46 - 0.59）。儿科患者的平均临终关怀住院时间比成人长（103天对66天，p<0.001）。儿童更有可能离开临终关怀护理（OR 2.59；95% CI：2.00 - 3.34），但在临终关怀期间死亡的患者中，儿科患者更有可能在家中死亡（OR 3.25；95% CI：2.27 - 3.88）。
儿科临终关怀患者与成人患者在基础诊断范围和临终关怀服务使用方面存在差异。
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