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Published on: June 21, 2018
Causes of death in critically ill paediatric patients in Japan: a retrospective multicentre cohort study
Tadashi Ishihara1, Hiroshi Tanaka1
1Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Insights
Most pediatric intensive care unit deaths involve children with chronic conditions. However, children without chronic illnesses were more likely to die from external causes, unlike those with chronic conditions who primarily died from intrinsic diseases.
Area of Science:
- Pediatric critical care medicine
- Mortality studies
- Epidemiology of pediatric death
Background:
- Understanding pediatric mortality in intensive care settings is crucial for improving patient outcomes.
- Chronic conditions significantly impact the clinical profiles and causes of death in critically ill children.
- Paediatric intensive care units (PICUs) and intensive care units (ICUs) manage a diverse range of critically ill children.
Purpose of the Study:
- To delineate the clinical characteristics of pediatric patients who died in ICUs or PICUs.
- To identify demographic disparities between pediatric decedents with and without chronic conditions.
- To analyze the causes of death in relation to the presence of chronic illnesses in critically ill children.
Main Methods:
- Retrospective multicenter cohort study utilizing the Japanese Registry of Pediatric Acute Care (JaRPAC) database.
- Inclusion criteria: Patients ≤16 years of age who died in a participating PICU or ICU between April 2014 and March 2017.
- Comparative analysis of causes of death between pediatric patients with and without chronic conditions.
Main Results:
- A total of 6199 pediatric patients were included, with 126 (2.1%) deaths recorded.
- Children with chronic conditions accounted for the majority of deaths (n=93) compared to those without (n=33).
- Extrinsic causes of death were significantly more prevalent in children without chronic illness (45%) than in those with chronic illness (11%; p<0.01). Cardiovascular disease was the most common chronic condition (29%).
Conclusions:
- The majority of pediatric deaths in intensive care settings occurred in children with pre-existing chronic conditions.
- Intrinsic diseases, particularly congenital heart disease and sepsis, were primary causes of death in children with chronic conditions.
- Children without chronic illnesses experienced a higher proportion of deaths due to extrinsic factors, alongside intrinsic causes like cardiovascular and neuromuscular diseases.
Objectives:
The primary objective is to clarify the clinical profiles of paediatric patients who died in intensive care units (ICUs) or paediatric intensive care units (PICUs), and the secondary objective is to ascertain the demographic differences between patients who died with and without chronic conditions.
Methods:
In this retrospective multicentre cohort study, we collected data on paediatric death from the Japanese Registry of Pediatric Acute Care (JaRPAC) database. We included patients who were ≤16 years of age and had died in either a PICU or an ICU of a participating hospital between April 2014 and March 2017. The causes of death were compared between patients with and without chronic conditions.
Results:
Twenty-three hospitals participated, and 6199 paediatric patients who were registered in the JaRPAC database were included. During the study period, 126 (2.1%) patients died (children without chronic illness, n=33; children with chronic illness, n=93). Twenty-five paediatric patients died due to an extrinsic disease, and there was a significant difference in extrinsic diseases between the two groups (children without chronic illness, 15 (45%); children with chronic illness, 10 (11%); p<0.01). Cardiovascular disease was the most common chronic condition (27/83, 29%). Eighty-three patients (85%) in the chronic group died due to an intrinsic disease, primarily congenital heart disease (14/93, 15%), followed by sepsis (13/93, 14%).
Conclusions:
The majority of deaths were in children with a chronic condition. The major causes of death in children without a chronic illness were due to intrinsic factors such as cardiovascular and neuromuscular diseases, and the proportion of deaths due to extrinsic causes was higher in children without chronic illness.
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