How Do Children Die in PICUs Nowadays? A Multicenter Study From Spain.

Area of Science:

• Pediatric critical care medicine
• Palliative care
• Epidemiology of child mortality

Background:

• Understanding patterns of death in pediatric intensive care units (PICUs) is crucial for improving care.
• Previous studies have explored end-of-life care, but data from Spain's PICUs require current description.

Purpose of the Study:

• To delineate the circumstances, epidemiological characteristics, and clinical diagnoses associated with pediatric deaths in Spanish PICUs.
• To analyze factors influencing end-of-life care decisions and outcomes in critically ill children.

Main Methods:

• A prospective, multicenter observational study was conducted across 18 Spanish PICUs.
• Data were collected on 250 children aged 1–16 years who died in PICU between 2017 and 2018.

Main Results:

• Life-sustaining treatment limitation (LSTL) was observed in 48.8% of deaths, most frequently involving withdrawal of mechanical ventilation.
• Children with LSTL were more likely to have chronic diseases, prior PICU admissions, and severe disabilities.
• Deaths occurred more often during afternoon/night shifts after a median PICU stay of 3 days.

Conclusions:

• Almost half of pediatric deaths in Spanish PICUs result from LSTL, particularly in vulnerable children.
• Healthcare professionals require specialized training to manage end-of-life care effectively in critically ill children.
• Findings underscore the importance of addressing LSTL and improving support for children with chronic conditions nearing end-of-life.