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

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.