1 Department of Health Sciences, University of York, York, UK.
2 Division of Epidemiology & Biostatistics, LICAMM, University of Leeds, Leeds, UK.
Palliat Med. 2018 Feb;32(2):337-346. doi: 10.1177/0269216317709711. Epub 2017 May 12.
Although child mortality is decreasing, more than half of all deaths in childhood occur in children with a life-limiting condition whose death may be expected.
To assess trends in place of death and identify characteristics of children who died in the community after discharge from paediatric intensive care unit.
National data linkage study.
SETTING/PARTICIPANTS: All children resident in England and Wales when admitted to a paediatric intensive care unit in the United Kingdom (1 January 2004 and 31 December 2014) were identified in the Paediatric Intensive Care Audit Network dataset. Linkage to death certificate data was available up to the end of 2014. Place of death was categorised as hospital (hospital or paediatric intensive care unit) or community (hospice, home or other) for multivariable logistic modelling.
The cohort consisted of 110,328 individuals. In all, 7709 deaths occurred after first discharge from paediatric intensive care unit. Among children dying, the percentage in-hospital at the time of death decreased from 83.8% in 2004 to 68.1% in 2014; 852 (0.8%) of children were discharged to palliative care. Children discharged to palliative care were eight times more likely to die in the community than children who died and had not been discharged to palliative care (odds ratio = 8.06 (95% confidence interval = 6.50-10.01)).
The proportion of children dying in hospital is decreasing, but a large proportion of children dying after discharge from paediatric intensive care unit continue to die in hospital. The involvement of palliative care at the point of discharge has the potential to offer choice around place of care and death for these children and families.
尽管儿童死亡率正在下降，但仍有一半以上的儿童死于生命有限的情况下，这些儿童的死亡是可以预期的。
评估死亡地点的趋势，并确定从儿科重症监护病房出院后在社区死亡的儿童的特征。
全国数据链接研究。
地点/参与者：在英国，所有在儿科重症监护病房住院的儿童（2004 年 1 月 1 日至 2014 年 12 月 31 日）均在儿科重症监护审计网络数据集（Paediatric Intensive Care Audit Network dataset）中确定。截至 2014 年底，可通过死亡证明数据进行链接。多变量逻辑模型将死亡地点分为医院（医院或儿科重症监护病房）或社区（临终关怀、家庭或其他）。
该队列由 110328 人组成。共有 7709 人在首次从儿科重症监护病房出院后死亡。在所有死亡儿童中，死亡时在医院的比例从 2004 年的 83.8%下降到 2014 年的 68.1%；852 名（0.8%）儿童被转至姑息治疗。与未转至姑息治疗而死亡的儿童相比，转至姑息治疗的儿童在社区死亡的可能性高出八倍（优势比=8.06（95%置信区间=6.50-10.01））。
在医院死亡的儿童比例正在下降，但仍有很大一部分在儿科重症监护病房出院后死亡的儿童继续在医院死亡。姑息治疗在出院时的介入有可能为这些儿童及其家庭提供护理和死亡地点的选择。
