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

Authors: Sands, Rebecca¹; Manning, Joseph C²; Vyas, Harish³; Rashid, Asrar

Source: Nursing in Critical Care, Volume 14, Number 5, September/October 2009 , pp. 235-240(6)

Publisher: Wiley-Blackwell

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.

Keywords: Death; End-of-life care; Paediatric intensive care; Service evaluation

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1478-5153.2009.00348.x

Affiliations: 1: Dr Rebecca Sands, MRCPCH, Paediatric Specialist Registrar, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK 2: Joseph C Manning, MNursSci (Hons), RN (Child), Staff Nurse, Paediatric Intensive Care Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK 3: Prof Harish Vyas, DM, FRCP, FRCPCH, Consultant Paediatric Intensivist, Paediatric Intensive Care Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, NG7 2UH, UK

Publication date: 2009-09-01

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