To characterize delivery of goal-concordant end-of-life (EOL) care among children with complex chronic conditions and to determine factors associated with goal-concordance.Retrospective review of goals of care discussions for 272 children with at least one complex chronic condition who died at a tertiary care hospital between 1/1/2014 and 12/31/2017. Goals of care and code status were assessed before and within the last 72 hours of life. Goals of care discussions were coded as: full interventions; considering withdrawal of interventions (palliation); planned transition to palliation; or actively transitioning/transitioned to palliation.In total, 158 children had documented goals of care discussions before and within the last 72 hours of life, 18 had goals of care discussions only72 hours before death, 54 only in the last 72 hours of life, and 42 had no documented goals of care. For children with goals of care, EOL care was goal-concordant for 82.2%, discordant in 7%, and unclear in 10.8%. Black children had over eight-fold greater odds of discordant care compared with White (OR=8.34, p=0.007). Comparison of goals of care and code status before and within the last 72 hours of life revealed trends toward non-escalation of care. Specifically, rates of active palliation increased from 11.7% to 63.0% and code status shifted from 32.6% do not resuscitate to 65.2% (p0.001).In this cohort, a majority of children had documented goals of care discussions and received goal-concordant EOL care. However, Black children had higher odds of receiving goal-discordant care. Goals of care and code status shifted toward palliation during the last 72 hours of life.