Udemgba Chinwe S, Palama Brett K, Darlington Wendy, Hoehn K Sarah
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Department of Pediatrics, University of Chicago, Comer Children's Hospital, Chicago, IL, USA.
Am J Hosp Palliat Care. 2025 Dec;42(12):1221-1228. doi: 10.1177/10499091251316570. Epub 2025 Jan 29.
Pediatric neuro-oncology patients have one of the highest mortality rates among all children with cancer. Our study examines the potential relationship between palliative care consultation and intensity of in-hospital care and determines if racial and ethnic differences are associated with palliative care consultations during their terminal admission. Retrospective observational study using the Pediatric Health Information System (PHIS) database with data from U.S. children's hospitals. PHIS was queried for patients under 18 years of age who received a diagnosis of brain tumor and had their terminal admission between January 1, 2017 and December 31, 2021. Of the 567 patients who fit the inclusion criteria, 359 (63%) patients had an inpatient palliative care consultation during their terminal hospital stay. There were no statistically significant differences seen when comparing palliative care consultation rates among racial groups. When comparing the ethnicity variables, patients in the Hispanic group had approximately a 10% higher rate of palliative care consultations than their non-Hispanic counterpart. Patients with palliative care consultations had a lower percentage of PICU admission (64.9 vs 83.2), mechanical ventilation (51.0 vs 76.0), and TPN use (18.1 vs 25.5) despite having similar lengths of stay. Pediatric neuro-oncology patients who received a palliative care consultation during their terminal hospital stay had lower intensity care (lower rates PICU admission, mechanical ventilation use, and TPN use) despite having similar lengths of stay. This may reflect the enhanced decision-making support for the patients and their families so that they may consider all options. Children facing a terminal illness and their families deserve access to optimal supportive services. This study highlights the importance of integrating palliative care in hospital admissions of terminally ill children with neuro-oncological diagnoses.
在所有患癌儿童中，儿科神经肿瘤患者的死亡率是最高的之一。我们的研究探讨了姑息治疗会诊与住院治疗强度之间的潜在关系，并确定种族和民族差异是否与他们临终入院期间的姑息治疗会诊有关。使用儿科健康信息系统（PHIS）数据库进行回顾性观察研究，该数据库包含来自美国儿童医院的数据。在PHIS中查询了2017年1月1日至2021年12月31日期间被诊断为脑肿瘤且临终入院的18岁以下患者。在符合纳入标准的567名患者中，359名（63%）患者在临终住院期间接受了住院姑息治疗会诊。比较不同种族群体的姑息治疗会诊率时，未发现统计学上的显著差异。比较种族变量时，西班牙裔组患者的姑息治疗会诊率比非西班牙裔组患者高出约10%。接受姑息治疗会诊的患者入住儿科重症监护病房（PICU）的比例（64.9%对83.2%）、机械通气的比例（51.0%对76.0%）和使用全胃肠外营养（TPN）的比例（18.1%对25.5%）较低，尽管住院时间相似。在临终住院期间接受姑息治疗会诊的儿科神经肿瘤患者，尽管住院时间相似，但护理强度较低（PICU入院率、机械通气使用率和TPN使用率较低）。这可能反映出为患者及其家属提供了更强的决策支持，以便他们可以考虑所有选择。面临绝症的儿童及其家庭应能获得最佳的支持性服务。这项研究强调了在患有神经肿瘤诊断的绝症儿童的住院治疗中纳入姑息治疗的重要性。
