Clinical Focus

  • Hospitalist
  • Pediatric Hospital Medicine

Academic Appointments

  • Clinical Instructor, Pediatrics

Honors & Awards

  • Honor Roll for Clinical Teaching of Medical Students, Stanford Children's Health (2022-2023)
  • Member, Gold Humanism Honor Society (2020)

Professional Education

  • Board Certification, American Board of Pediatrics, Pediatrics (2023)
  • Residency: Stanford University Pediatric Residency at Lucile Packard Children's Hospital CA
  • Medical Education: University of Hawaii at Manoa John A Burns School of Medicine (2020) HI
  • BS, Santa Clara University, Biology, Public Health (2015)

Contact

  • Academic
    brittnik@stanford.edu
    University - Academic staff Department: Peds/Hospital Medicine Position: Clinical Instructor
  • Clinical (Primary)  Lucile Packard Children's Hospital - Hospital Medicine 725 Welch Rd Palo Alto, CA 94304 (650) 736-6690 (fax)

Additional Clinical Info

Additional Info

  • Mail Code: 5660

All Publications

  • Trajectories in Intensity of Medical Interventions at the End of Life: Clustering Analysis in a Pediatric, Single-Center Retrospective Cohort, 2013-2021. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Liesse, K. M., Malladi, L., Dinh, T. C., Wesp, B. M., Kam, B. N., Turturice, B. A., Pyke-Grimm, K. A., Char, D. S., Hollander, S. A. 2024

    Abstract

    OBJECTIVE: Pediatric deaths often occur within hospitals and involve balancing aggressive treatment with minimization of suffering. This study first investigated associations between clinical/demographic features and the level of intensity of various therapies these patients undergo at the end of life (EOL). Second, the work used these data to develop a new, broader spectrum for classifying pediatric EOL trajectories.DESIGN: Retrospective, single-center study, 2013-2021.SETTING: Four hundred sixty-one bed tertiary, stand-alone children's hospital with 112 ICU beds.PATIENTS: Patients of age 0-26 years old at the time of death.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: Of 1111 included patients, 85.7% died in-hospital. Patients who died outside the hospital were older. Among the 952 in-hospital deaths, most occurred in ICUs (89.5%). Clustering analysis was used to distinguish EOL trajectories based on the presence of intensive therapies and/or an active resuscitation attempt at the EOL. We identified five simplified categories: 1) death during active resuscitation, 2) controlled withdrawal of life-sustaining technology, 3) natural progression to death despite maximal therapy, 4) discontinuation of nonsustaining therapies, and 5) withholding/noninitiation of future therapies. Patients with recent surgical procedures, a history of organ transplantation, or admission to the Cardiovascular ICU had more intense therapies at EOL than those who received palliative care consultations, had known genetic conditions, or were of older age.CONCLUSIONS: In this retrospective study of pediatric EOL trajectories based on the intensity of technology and/or resuscitation discontinued at the EOL, we have identified associations between these trajectories and patient characteristics. Further research is needed to investigate the impact of these trajectories on families, patients, and healthcare providers.

    View details for DOI 10.1097/PCC.0000000000003579

    View details for PubMedID 39023327