Evaluation of discharge to palliative care following critical care: a pediatric intensive care perspective.

UNLABELLED: This study aimed to analyze the demographic and clinical characteristics of patients transferred from the pediatric intensive care unit (PICU) to the pediatric palliative care unit (PPCU), and to assess the independent impact of medical technology dependence-including mechanical ventilation, tracheostomy, and percutaneous endoscopic gastrostomy (PEG)-on PICU length of stay (LOS) and readmission frequency. This retrospective, single-center study analyzed the records of 303 patients transferred from a tertiary-level PICU to a pediatric palliative care unit between January 1, 2023, and December 31, 2025. Demographic data, diagnostic groups, PICU length of stay, mechanical ventilation (MV), tracheostomy (TK), and PEG status were analyzed. Binary logistic regression was performed to identify independent predictors of multiple PICU readmissions (≥ 2 admissions) and prolonged LOS (> 15 days). Of 4,083 PICU discharges, 303 (7.4%) transferred to PPCU; 43.2% had neurological disorders. Tracheostomy independently predicted multiple readmissions (OR = 2.06, p = 0.042) and prolonged stay (OR = 2.59, p = 0.009). Ventilation predicted prolonged stay (OR = 7.47, p = 0.013), whereas PEG predicted shorter stay (OR = 0.37, p < 0.001). Female gender predicted higher readmissions (p = 0.003). CONCLUSION: Technology dependence-particularly tracheostomy and mechanical ventilation-is a key independent determinant of prolonged PICU occupancy and recurrent hospitalizations among children requiring palliative care. These findings underscore the need to optimize the integration of palliative care within intensive care workflows and to establish comprehensive, multidisciplinary post-discharge follow-up protocols. WHAT IS KNOWN: • Global PPCU admissions after PICU discharge are rising due to increased survival of complex chronic patients. • Tracheostomy, gastrostomy, and ventilation mark technology dependence. WHAT IS NEW: • Largest Turkish cohort ($$n=303$$) tracking PICU-to-palliative transitions (7.4% of discharges). • Tracheostomy and ventilation predicted prolonged stay; PEG feeding correlated with shorter stay.