380 - Evaluating Differences Between Pediatric And Adult Clinical Ethics Consultations

Publication Number: 4372.380

Claire E. Brock, New York University Grossman School of Medicine, New York, NY, United States; Matthew Lin, New York University Grossman School of Medicine, New York, NY, United States; Catherine Constable, NYU Langone Health, New York, NY, United States; Steven Field, New York University Grossman School of Medicine, New York, NY, United States; Kristyn A. Pierce, New York University Grossman School of Medicine, New York, NY, United States; Robert Angert, New York University Grossman School of Medicine, NEW YORK, NY, United States; Arthur Caplan, New York University Grossman School of Medicine, New York, NY, United States; Daniel S. Eison, New York University Grossman School of Medicine, New York, NY, United States; Joseph Lowy, NYU Langone, NEW YORK, NY, United States; Gwynne Latimer, New York University Grossman School of Medicine, New York, NY, United States

Background: Clinical ethics consultations (CEC) aim to improve the quality and delivery of healthcare by identifying, evaluating, and resolving ethical questions or conflicts. Although adult CECs are well studied, less is known about pediatric cases and how their underlying ethical issues differ or overlap with those in adults.

Objective: This study aims to describe and evaluate differences in the demographic, medical, and consultation characteristics of pediatric vs. adult patients who receive CECs.

Design/Methods: A retrospective review of pediatric and adult CECs at an urban academic center with an embedded non-freestanding children's hospital was conducted over a 3-year period (April 2023-June 2025). Our CEC service is currently staffed by 3 adult medicine clinicians with ad hoc input from 2 pediatricians. Subjects were identified through CEC logs, and demographic, medical, and CEC characteristics were abstracted from medical records. Categorical variables were summarized with proportions and 95% confidence intervals (CIs) and continuous variables with means and standard deviations (SDs). Differences between pediatric and adult cases were assessed with 95% CIs to convey the precision of the estimate.

Results: A total of 155 CECs were performed during the study period, 11 of whom were pediatric patients (Fig 1). Four adult and one pediatric patient could not be located in the medical record based on CEC log data. The White race was most frequent in both pediatric (3/9, 33%) and adult patients (78/126, 62%) (Table 1). Pediatric patients tended to have longer mean lengths of stay (mean difference=51, 95% CI 23-79), more subspecialty consultations (mean difference=4, 95% CI=2-6), and more family meetings (mean difference=4, 95% CI=3-5). End-of-life/beginning-of-life issues were more common reasons for pediatric CECs (difference 58%, 95% CI 29-87), which also showed greater legal team involvement (difference 44%, 95% CI 22-74) and more frequent documentation in CEC notes (difference 31%, 95% CI 1-60) compared to adults.

Conclusion(s): Preliminary patterns suggest potential differences in the clinical and CEC characteristics between adult and pediatric patients. Given our study's limited sample size, our results are descriptive and exploratory, and should be interpreted with caution. Future research should aim to characterize and confirm these differences in larger, more diverse populations to identify the unique ethical needs of pediatric patients in non-freestanding children's hospitals. Understanding these needs may present opportunities to better inform pediatric ethics program building, education and research.

Figure 1. Number of adult and pediatric clinical ethics consultations (CEC) from April 2023-June 2025.
For 2023 and 2024, there were 2 (adult) and 3 (2 adult and 1 pediatric) patients who could not be located in the medical record based on CEC log data, respectively.

Table 1. Demographic, care utilization, and clinical ethics consultation characteristic differences (mean and proportion) for pediatric vs. adult patients.
E/B= end-of-life and beginning-of-life issues, BERT=behavioral emergency response team utilized, SDM=shared decision-making, SD=standard deviation.
Grouping of response categories described below:
1: SDM=treatment adherence/refusal, surrogate question/capacity, requests for care outside the standard, consent/assent
2: Institutional=patient privacy/confidentiality, professionalism, resource allocation, business and management, conscientious objection, unprofessionalism, research ethics, policy/guideline clarification
3: General=moral distress, forum for discussion, recommendations for care, conflict resolution, explanation of options, values clarification
4: E/B of life=intensity or limitation of treatment/withdrawing or withholding interventions, ethical