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Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death

Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death
Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death
Aim
To compare indicators of high intensity treatment at end‐of‐life (HI‐EOL) among children according to causes of death.

Methods
We conducted a nationwide registry study in Denmark among 938 children of 1‐17 years of age who died from natural causes from 2006 to 2016. We identified and compared indicators of HI‐EOL within the last month of life across diagnoses. Indicators were hospital admissions, days in hospital, intensive care unit admission, mechanical ventilation, and hospital death.

Results
Proportions of each indicator of HI‐EOL ranged from 27% to 75%. The most common indicators were hospital death (75%) and ICU admission (39%). Compared to children with solid tumours, children with non‐cancerous conditions had an adjusted odds ratio of 3.5 (95% CI 2.1‐5.9) of having ≥3 indicators of HI‐EOL within the last month of life and children with haematological cancer had an odds ratio of 11.8 (95% CI 6.1‐23.0).

Conclusion
The underlying diagnosis was strongly associated with HI‐EOL. Children who died from solid tumours experienced substantially less intensive treatment than both children with haematological cancer and non‐cancerous conditions did. Across non‐cancerous diagnoses, the intensity of treatment appeared consistent, which may indicate, that the awareness of palliative care is higher among oncologists than within other paediatric fields.
0803-5253
Wolff, S
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Christiansen, C
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Johnsen, S
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Schroeder, H
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Darlington, A
472fcfc9-160b-4344-8113-8dd8760ff962
Neergaard, Ma
71c42562-1b56-4843-b63c-0ffc7032a62a
Wolff, S
546d638d-06fa-4ea6-a2a4-cbc99feadc15
Christiansen, C
b1993f77-2024-4daf-b5d8-1ce837315564
Johnsen, S
a3c54783-4d8c-4a3c-8bd5-f99cff14e2c9
Schroeder, H
0b965b39-f1ba-4b53-82e7-b78c1240ec92
Darlington, A
472fcfc9-160b-4344-8113-8dd8760ff962
Neergaard, Ma
71c42562-1b56-4843-b63c-0ffc7032a62a

Wolff, S, Christiansen, C, Johnsen, S, Schroeder, H, Darlington, A and Neergaard, Ma (2020) Disparities in intensity of treatment at end‐of‐life among children according to the underlying cause of death. Acta Paediatrica. (doi:10.1111/apa.15713).

Record type: Article

Abstract

Aim
To compare indicators of high intensity treatment at end‐of‐life (HI‐EOL) among children according to causes of death.

Methods
We conducted a nationwide registry study in Denmark among 938 children of 1‐17 years of age who died from natural causes from 2006 to 2016. We identified and compared indicators of HI‐EOL within the last month of life across diagnoses. Indicators were hospital admissions, days in hospital, intensive care unit admission, mechanical ventilation, and hospital death.

Results
Proportions of each indicator of HI‐EOL ranged from 27% to 75%. The most common indicators were hospital death (75%) and ICU admission (39%). Compared to children with solid tumours, children with non‐cancerous conditions had an adjusted odds ratio of 3.5 (95% CI 2.1‐5.9) of having ≥3 indicators of HI‐EOL within the last month of life and children with haematological cancer had an odds ratio of 11.8 (95% CI 6.1‐23.0).

Conclusion
The underlying diagnosis was strongly associated with HI‐EOL. Children who died from solid tumours experienced substantially less intensive treatment than both children with haematological cancer and non‐cancerous conditions did. Across non‐cancerous diagnoses, the intensity of treatment appeared consistent, which may indicate, that the awareness of palliative care is higher among oncologists than within other paediatric fields.

Text
apa.15713 - Accepted Manuscript
Restricted to Repository staff only until 8 December 2021.
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More information

Accepted/In Press date: 16 November 2020
e-pub ahead of print date: 8 December 2020

Identifiers

Local EPrints ID: 445648
URI: http://eprints.soton.ac.uk/id/eprint/445648
ISSN: 0803-5253
PURE UUID: 95c5b5ee-5a43-4055-b316-6760cd845555

Catalogue record

Date deposited: 05 Jan 2021 17:31
Last modified: 25 Nov 2021 19:38

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Contributors

Author: S Wolff
Author: C Christiansen
Author: S Johnsen
Author: H Schroeder
Author: A Darlington
Author: Ma Neergaard

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