Characteristics of deaths in paediatric intensive care: a 10-year study

Nurs Crit Care. Sep-Oct 2009;14(5):235-40. doi: 10.1111/j.1478-5153.2009.00348.x.

Abstract

Objective: To describe the patient mortality over a 10-year period in a paediatric intensive care unit (PICU) including patient demographics, length of stay, cause and mode of death and to compare these findings with pre-existing literature from the western world.

Design: A retrospective chart review.

Setting: A UK tertiary PICU.

Patients: All children who died in the PICU over a 10-year period between 1 November 1997 and 31 October 2007 (n = 204).

Interventions: None.

Measurements and main results: Data recorded for each patient included patient demographics, length of stay and cause of death according to the International Classification of Disease-10 classification, and mode of death. Mode of death was assigned for each patient by placement in one of four categories: (i) brain death (BD), (ii) managed withdrawal of life-sustaining medical therapy (MWLSMT), (iii) failed cardiopulmonary resuscitation (CPR) and (iv) limitation of treatment (LT). Over the study period, findings showed a median length of stay of 2 days (IQR 0-5 days), with a mortality rate of 5%. The most common mode of death was MWLSMT (n = 112, 54.9%) and this was consistent across the 10-year period. Linear regression analysis demonstrated no significant change in trend over the 10 years in each of the modes of death; BD (p = 0.84), MWLSMT (p = 0.88), CPR (p = 0.35) and LT (p = 0.67).

Conclusion: End-of-life care is an important facet of paediatric intensive nursing/medicine. Ten years on from the Royal College of Paediatrics and Child Health publication 'Withholding or withdrawing life sustaining treatment in children: A framework for practice', this study found managed withdrawal of MWLSMT to be the most commonly practised mode of death in a tertiary PICU, and this was consistent over the study period.

MeSH terms

  • Adolescent
  • Age Distribution
  • Brain Death / diagnosis
  • Cardiopulmonary Resuscitation / trends
  • Cause of Death / trends
  • Child
  • Child Mortality / trends*
  • Child, Preschool
  • England / epidemiology
  • Female
  • Hospital Mortality / trends*
  • Hospitals, Teaching / trends
  • Humans
  • Infant
  • Intensive Care Units, Pediatric / trends*
  • International Classification of Diseases / trends
  • Length of Stay / trends
  • Linear Models
  • Male
  • Medical Audit
  • Patient Admission / trends
  • Retrospective Studies
  • Sex Distribution
  • Statistics, Nonparametric
  • Terminal Care / trends
  • Treatment Failure
  • Withholding Treatment / trends