{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:57:43Z","timestamp":1781153863309,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study describes the location, mode of death, palliative care and advance care planning (ACP) use amongst children who died at KK Women's and Children's Hospital (KKH), Singapore, between 2011 and 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Medical records of all children who died in the general ward, high dependency unit and paediatric intensive care unit (PICU) were reviewed. Data collected included: demographics, diagnosis, cause, location, mode of death, palliative care and ACP use. Trends were analysed using the Mann\u2013Kendall test and compared using logistic regression. A\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value of &lt;\u20090.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Amongst 326\u2009372 hospital admissions, 412 children (0.13%) died, of whom 270 (65.5%) had at least one complex chronic condition (CCC). Most deaths occurred in the PICU (319\/412, 77.4%), and 188 children (45.6%) died following non\u2010escalation of care. Palliative care consultations were provided in 119 cases (28.9%), and ACP was documented in 25 cases (6.1%). From 2011 to 2020, palliative care consultations increased from 20.4% to 39.3% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06) and ACP use increased from 0% to 15.2% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Over the same period, deaths after withdrawal of life\u2010sustaining measures (WLSM) increased from 14.3% to 30.3% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.09), whilst deaths in the general ward decreased from 12.2% to 6.1% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.36).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most hospitalised children died in the PICU following non\u2010escalation of care without palliative care or ACP use. Future research is needed to identify the barriers and facilitators to their use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70365","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T07:14:10Z","timestamp":1774077250000},"page":"953-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology of Inpatient Paediatric Mortalities From 2011 to 2020: A Retrospective Review"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9168-1205","authenticated-orcid":false,"given":"Sherry Zhi Qing","family":"Low","sequence":"first","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8430-4217","authenticated-orcid":false,"given":"Jan Hau","family":"Lee","sequence":"additional","affiliation":[{"name":"Children's Intensive Care Unit, Department of Paediatric Subspecialties KK Women's and Children's Hospital  Singapore Singapore"},{"name":"SingHealth\u2010DukeNUS Paediatrics Academic Clinical Programme Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-5571","authenticated-orcid":false,"given":"Rehena","family":"Sultana","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Lei Bianche","family":"Lim","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Beng","family":"Ang","sequence":"additional","affiliation":[{"name":"Medical Social Work Department KK Women's and Children's Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poh Hui","family":"Wee","sequence":"additional","affiliation":[{"name":"Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1512-2660","authenticated-orcid":false,"given":"Joel Kian Boon","family":"Lim","sequence":"additional","affiliation":[{"name":"Children's Intensive Care Unit, Department of Paediatric Subspecialties KK Women's and Children's Hospital  Singapore Singapore"},{"name":"SingHealth\u2010DukeNUS Paediatrics Academic Clinical Programme Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.14771"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000520"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.17352"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/children12040440"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"192","article-title":"Do Children Die? A Retrospective Review of Deaths in a Children's Hospital","volume":"53","author":"Chong P. H.","year":"2012","journal-title":"Singapore Medical Journal"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/pxx005"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2929.2006.02479.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2010.0314"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.47102\/annals\u2010acadmedsg.2024247"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.106.S1.205"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2021.0205"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887\u2010017\u20100981\u2010y"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)60560\u20101"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000317"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/children9101540"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0111"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.5351"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7386"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2008.0015"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2022.01.016"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2023.06.024"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241271010"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2016.0451"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012\u20102394"}],"container-title":["Journal of Paediatrics and Child Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jpc.70365","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jpc.70365","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jpc.70365","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:05:12Z","timestamp":1781150712000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jpc.70365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,21]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/jpc.70365"],"URL":"https:\/\/doi.org\/10.1111\/jpc.70365","archive":["Portico"],"relation":{},"ISSN":["1034-4810","1440-1754"],"issn-type":[{"value":"1034-4810","type":"print"},{"value":"1440-1754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,21]]},"assertion":[{"value":"2025-09-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}