Child death in the emergency department: experience from a 10-year retrospective review.

Objective: To describe the demographic characteristics, causes and temporal patterns of child deaths occurring in a paediatric emergency department (ED) over a 10-year period.

Design: Single-centre retrospective observational study.

Setting: A major trauma centre in the UK with a standalone paediatric ED.

Patients: 58 children aged 0-17 years who died in the ED or were brought in dead between January 2014 and December 2023.

Interventions: None.

Main outcome measures: Causes of death, demographics, seasonal and diurnal variation, parental presence and safeguarding concerns.

Results: Median age at death was 2 years. The highest proportion of deaths occurred among infants under 1 year (36%) and adolescents aged 13-17 years (31%). Leading causes of death included sudden unexpected deaths (26%), infections (24%) and acute medical or surgical conditions (16%). Overall mortality was highest during winter months (29%), notably due to infections (50% of infection-related deaths). Sudden unexpected deaths showed clear early morning peaks, with 40% occurring between 04:00 and 07:59. Adolescents (13-17 years) represented 31% of deaths, predominantly due to infections and suicide or self-harm. Parental presence during resuscitation was high (83%). Prior safeguarding concerns were documented in 28% of cases, rising to 100% in deaths due to inflicted injury or abuse.

Conclusions: Child deaths in the ED present distinct patterns differing from national childhood mortality statistics, emphasising sudden and acute conditions. Recognising these unique characteristics can guide improvements in clinical practice, ED-specific bereavement support, targeted staff training and resource allocation for periods of highest risk.