The objectives are as follows: 1) estimate palliative care consult rates and trends among critically ill children and 2) characterize which children receive palliative care consults, including those meeting previously proposed ICU-specific palliative care screening criteria. DESIGN: Retrospective cohort.

OBJECTIVES: To determine the validity of palliative care (PC) administrative codes (V66.7 and Z51.5) among critically ill pediatric patients. METHODS: In this single-center retrospective cohort study, we included all hospitalizations with a PICU admission between March 2016 and March 2018. Sensitivity, specificity, and positive and negative predictive values of the relevant codes were estimated by using a gold standard of a local PC registry. RESULTS: During the study period, 4670 hospitalizations were included. The median admission age was 5 years (interquartile range 1.5–12.9) with 55% having at least 1 complex chronic condition. The median length of PICU stay was 1.8 days (interquartile range 1–3.4) and mortality was low (1.3%). A total 182 (3.9%) hospitalizations had evidence of a PC consultation. Administrative codes for PC had a sensitivity of 11% (95% confidence interval [CI] 6.8%–16.5%) and a specificity of 99.8% (95% CI 99.6%–99.9%). The positive and negative predictive values were 66.7% (95% CI 47.2%–82.7%) and 96.5% (95% CI 95.9%–97.0%), respectively. CONCLUSIONS: Among critically ill children, PC administrative codes had high specificity but poor sensitivity. The potential for underascertainment of this resource should be considered in future research using administrative data.

Non-linear, non-branched (NLNB) virtual patient (VP) models have no defined paths or branches and emulate the "real world" where health professionals evaluate and manage their patients contemporaneously. This model has not been evaluated in prior studies but has potential to increase trainee interactivity and clinical reasoning. We evaluated NLNB VPs engagement by third-year medical students. After reading an initial clinical vignette students used a single textbox with an autocomplete feature to find keywords and select associated actions needed to provide care for their virtual patients. As students found and selected actions their engagement varied significantly based on the content the author provided. This commitment of time indicated the students' interest in the author-provided content. Students used intrinsic motivation to gathered data and provide interventions. They used free text to add items to a problem list and the differential diagnosis. They were cognitively immersed. Sixty-four students engaged a mean of 2.69 NLNB VPs where actions were not categorized or listed. Students found actions to provide care for the virtual patient when well-defined paths or branches were absent. NLNB VPs transfer control of the path and decisions to the trainees thereby increasing interactivity and potentially promoting critical thinking.

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