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Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study

Lorna K Fraser1, Roger Parslow2

  • 1Department of Health Sciences, University of York, York, UK.

Archives of Disease in Childhood
|July 15, 2017
PubMed

Insights

Children with life-limiting conditions (LLCs) represent a significant portion of paediatric intensive care unit (PICU) admissions and deaths. These children face a substantially higher risk of mortality both in PICU and during the year following discharge.

Area of Science:

  • Pediatric Critical Care Medicine
  • Palliative Care
  • Health Services Research

Background:

  • Life-limiting conditions (LLCs) in children are complex and require specialized care.
  • Paediatric intensive care units (PICUs) manage critically ill children, including those with LLCs.
  • Understanding the outcomes for children with LLCs in PICU is crucial for service planning.

Purpose of the Study:

  • To quantify the number of children admitted to PICU with LLCs.
  • To determine the outcomes for these children during PICU stay and post-discharge.
  • To identify opportunities for improved care integration.

Main Methods:

  • A national cohort, data-linkage study was conducted using the Paediatric Intensive Care Audit Network dataset.
  • Children admitted to UK PICUs between 2004 and 2015 were identified.
  • International Classification of Diseases (ICD10) codes were used to identify children with LLCs; logistic regression and survival modeling analyzed outcomes.

Main Results:

  • Children with LLCs constituted 57.6% of PICU admissions and 72.9% of PICU deaths.
  • The mortality rate in PICU was higher for children with LLCs (5.4%) compared to those without (2.7%).
  • Children with LLCs were 75% more likely to die in PICU and 2.5 times more likely to die within a year post-discharge.

Conclusions:

  • Children with LLCs form a substantial part of the PICU population.
  • There is a need to integrate specialist paediatric palliative care with critical care.
  • Integration can improve choices regarding place of care for children with LLCs and their families.
Abstract

Keywords:
ChildLife-Limiting ConditionsPICUPalliative CareSurvival

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