(860) Understanding PICU Mortality and Family Bereavement: A Single-Center Qualitative Study

Introduction: Pediatric mortality is an often underestimated and overlooked figure but has significant impact on providers and families. University Hospitals Rainbow Babies and Children has launched a program to identify factors surrounding pediatric mortality and develop initiatives for family bereavement. We hypothesize that elucidation of the characteristics of pediatric death in the PICU will aide understanding of long term consequences of bereavement and help develop unique therapeutic interventions.

Methods: Records of pediatric patients who had an in-hospital death in 2022 were evaluated. Included was patients from 0 months to 18 years of age at death, and excluded infants classified as intrauterine deaths or patients >18 years. Preliminary analysis focused on patients who died in the PICU and included demographics and characteristics including age, admission date, death date, cause of death, code status, involvement with palliative care, and co-existing morbidities.

Results: In 2022, 66 pediatric deaths occurred at RBC hospital with 19 patients in the PICU with the following characteristics: 63% male, 47% less than 1 year of age, 100% with English as a primary language, and 37% White, 47% Black and 16% unknown/other race. 37% of patients lived in zip codes with >25% of households below the poverty level, and 68% of patients lived in zip codes with >13.9% of households below the poverty level. The mean time from PICU admission to death was 7 days and 43 minutes: 26% of deaths occurring within 1 day of admission and 74% of deaths occurring within 1 week of admission. 68% had code status discussions resulting in a DNR order. The majority (92%) of the DNR orders were placed by the PICU compared to the palliative care team (8%). The mean time from code status implementation to death was 1 day, 7 hours, and 25 minutes.

Conclusions: This data suggests that the majority of PICU deaths are relatively acute, exist among a majority lower socioeconomic class, and a majority had limitations of care at end of life. This data can aide us as we attempt to stratify family characteristics, follow families longitudinally to assess for negative bereavement sequelae and personalize a bereavement plan for families. Further work will characterize death from the past 20 years and retrospectively evaluate these outcomes.