(812) Understanding PICU Mortality and Family Phenotyping: A 10-Year Retrospective Analysis

Introduction: Pediatric death is an underestimated and overlooked figure but has longstanding impact on providers and families. University Hospitals has launched a program to develop family bereavement services. Our aim is to identify the characteristics of pediatric death in the PICU and analyze relationships that could aid in the development of personalized bereavement interventions.

Methods: Retrospective chart review from 2013 to 2022 was performed of pediatric patients who died in the PICU. Inclusion criteria were patients from 0 months to 18 years of age at time of death. Exclusion criteria were patients living outside of Ohio and patients outside our age criteria. Variables obtained included demographics, admission and death dates, cause of death, code status, palliative care consult, involvement of support services and co-existing morbidities. Nationally normed ZIP code-level COI data was obtained based on patient's geographic location.

Results: Over 10 years, 175 patients died in the PICU. Majority were English speaking and race was predominately divided between White and Black. For age at death, 35.4% were < 1 years old, 31.4% were between 1-10 years, and 33.1% were >10 years old. Geospatial analysis showed most families living in areas with very low COI (43%) and low COI (17%). The top causes of death were acute medical/surgical causes, infection, and traumatic injury. 37% of deaths occurred within two days of admission, and 64% of deaths occurred within one week of admission. 72.5% had end of life discussions resulting in DNR (56.9%) or comfort measures (15.6%). Mean time from DNR to death was 3 days and 7 hours. There was no significant difference for limitation of care between race (78.4% White vs 67% Black, p = 0.11) or COI levels (65.8% of families with high COI vs 72.4% of families with low COI, p = 0.44).

Conclusions: Majority of PICU deaths occur in younger children and within one week from admission. Over half the patients had limitations of care; and on average, code orders were implemented a few days prior to death. Most families were living in areas with higher socioeconomic vulnerability. There did not appear to be a significant difference in limitation of care between races and COI levels. We can use these results to develop palliative care strategies focused on family phenotypes.