ICD-10–based screening increased detection of hospitalisations potentially eligible for paediatric palliative care consultation in the emergency department: a validation study

BACKGROUND: Despite emergency departments (ED) having traditionally focused on disease reversal and survival goals, care in these settings also involves paediatric patients with life-limiting or life-threatening conditions (LLC/LTC) who experience acute exacerbations of their illnesses. Early identification of these patients may help address unmet needs and enhance care provision. We aimed to assess the performance of the International Classification of Diseases, 10th Revision (ICD-10)-based screening strategy to detect paediatric patients potentially eligible for paediatric palliative care (PPC) team consultation in a Brazilian ED. METHODS: We conducted a cross-sectional study of 1,000 paediatric hospitalisations in the ED of a tertiary teaching hospital in Brazil (March 2020-March 2021). Potentially eligible hospitalisations were screened using Himelstein's criteria, informed by ICD-10-based classifications of LLC/LTC, paediatric complex chronic conditions, and multidisciplinary PPC team input. Eligibility was confirmed through chart review and multidisciplinary discussion. Screening performance was evaluated using standard diagnostic accuracy measures. RESULTS: Eighty-three hospitalisations were confirmed as potentially eligible for PPC consultation. The ICD-10-based strategy showed high sensitivity (0.99) and negative predictive value (1.00), with moderate specificity (0.73) and low positive predictive value (0.25). It increased case detection by 1.5-fold. Eligible hospitalisations were associated with younger age, higher mortality, and longer length of stay. CONCLUSIONS: ICD-10-based screening was a high-sensitivity strategy for identifying paediatric hospitalisations potentially eligible for PPC consultation. Although not sufficient as a stand-alone diagnostic approach, it may support systematic case-finding and earlier identification of unmet PPC needs, particularly in settings with limited-service integration.