Authors (including presenting author) :
SL Ng (1), SS Man (2), E Leung (3), N Chan (4), J Tsang (5), Karen KY Leung (1)
Affiliation :
(1) Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital (2) Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital (3) Medical Social Service Unit, Hong Kong Children's Hospital, Hong Kong SAR, China (4) Clinical Psychology, Kowloon Hospital, Hong Kong SAR, China (5) Nursing Department, Hong Kong Children's Hospital
Keyword 1: :
Paediatric Palliative Care
Keyword 2: :
Paediatric Intensive Care Unit
Keyword 3: :
End-of-Life Care
Keyword 4: :
Referral and Consultation
Keyword 5: :
Do-Not-Resuscitate Orders
Introduction :
alliative care in the paediatric intensive care unit (PICU) prioritises on symptom management, family support, and end-of-life planning for children with life-limiting conditions. There are studies point out that utilisation of palliative care services in PICU is not adequate1,2,3. At Hong Kong Children's Hospital (HKCH), palliative care services integrate multidisciplinary teams, yet utilisation in acute PICU settings remains understudied, with potential gaps in timely referrals amid curative priorities.
Objectives :
To evaluate the delivery of palliative care in PICU deaths, including referral rates, timing, indications, end-of-life support, and do-not-resuscitate (DNR) decisions, stratified by diagnostic categories.
Methodology :
A retrospective review of 30 PICU deaths at HKCH PICU from January 2024 to August 2025 was performed. Data included demographics, length of stay, diagnosis (oncology, cardiology, infection, others), paediatric palliative care team (PPC) referral timing and indications, end-of-life (EOL) support, and DNR status.
Result & Outcome :
Thirty children (age 1 day to 18 years, median 1.5 years) were analyzed. Diagnosis includes oncology (N=11, 36.7%), cardiology (N=10, 33.3%), infection (N=4, 13.3%), and others (N=5, 16.7%). The median length of stay in PICU was 29.5 days (range 1-111 days). PPC was referred in 93.3% cases (N=28), with timing as before admission (N=6), upon admission (N=2), or during stay (day 1–118, median day= 11.5; N=20). Indication for PPC referral includes severe diagnosis (N=11), acute deterioration (N=11), and terminal illness (N=6). Non-referrals were due to short admissions. PPC was present during EOL events in 86.6% (N=26) cases. Absence of PPC during EOL (N=4) was due to non-referral(N=2), family preference (N=1) and family being well prepared before the EOL event (N=1). DNR decisions were made in 83.3% (N=25) of death cases, with exceptions linked to parent preferences or brief stays. Palliative care was well integrated in HKCH PICU, with high referral rates and good EOL supports. High integration was due to high vigilance of the PICU team and the availability of PPC for 24/7 EOL supports for referred cases. Identified service gaps include missed referrals in short admissions, delayed referrals, lack of standardized psychological protocols for acute deterioration, and prolonged PICU stays. Future enhancements could include standardized psychological screening protocols for acute cases and measures to facilitate palliative cases to be discharged from PICU.
