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[Modality and causes of 259 deaths in a pediatric intensive care unit]
1Service de réanimation infantile, hôpital Calmette, Lille, France.
Insights
Brain death was the most common cause of death in European pediatric intensive care units (PICUs). Most deaths were not avoidable, but some resulted from dehydration in children with gastroenteritis.
Area of Science:
- Pediatric critical care medicine
- Mortality studies
- Intensive care unit outcomes
Context:
- Limited data exist on mortality patterns in European pediatric intensive care units (PICUs).
- Understanding causes of death is crucial for improving pediatric critical care.
- This study analyzes modes and causes of death in a European PICU over seven years.
Purpose:
- To investigate the modes and causes of death in a European pediatric intensive care unit (PICU).
- To classify deaths into brain death (BD), unsuccessful resuscitation (UR), and limitation/withdrawal of therapy (LWT).
- To identify factors associated with different modes of death and potential avoidability.
Summary:
- Brain death (BD) was the most frequent mode of death (38%), followed by unsuccessful resuscitation (UR) (34%) and limitation/withdrawal of therapy (LWT) (28%).
- Organ system failure varied by death group, with CNS failure prominent in LWT and cardiovascular failure in UR.
- While most deaths were unavoidable, 12% were deemed potentially avoidable, primarily due to dehydration from gastroenteritis.
Impact:
- Findings provide insights into pediatric mortality in European PICUs, aiding comparative analysis with North American units.
- Highlights the need for careful assessment of illness severity and functional outcomes in survivors.
- Identifies specific causes of avoidable death, informing targeted interventions and quality improvement efforts.
Background:
There are few data available from European pediatric intensive care units (PICU) regarding the modes of death and their causes.
Population And Methods:
Two hundred and fifty nine children, not including neonates, died in the PICU over a 7-year period (1987-1993). Data were obtained from a computerized data base and the retrospective review of medical records by two intensivists. Deaths were classified into three groups according to the terminal event: brain death (BD), unsuccessful resuscitation (UR), do-not-resuscitate order and limitation and/or withdrawal of therapy (LWT).
Results:
BD was the most common mode of death (38%); UR accounted for 34% and LWT for 28% of deaths. There was no significant annual variation in the proportion of BD, UR and LWT. Age and sex were similar in the three groups. The predominant organ system failure involved upon admission was the central nervous system (52%) in the LWT group, and the cardiovascular system (54%) in the UR group. Severe chronic disease (37%) and immunosuppression (19%) were more prevalent in the LWT group than in the BD group. Time from admission to death was longer in the LWT group (median = 119 hours) as compared to the UR group (10 hours) and the BD group (54 hours). Ten percent of the BD patients became organ transplant donors. Sixty-seven per cent of BD patients had medical contraindication for organ donation: parents did not accept organ donation in 61% of potential cases. Thirty deaths (12%) seemed to be avoidable; dehydration from acute infectious gastroenteritis (n = 7) was the most common cause of avoidable death.
Conclusions:
The modes of death in our PICU were statistically not different from those seen in two of four North-American PICUs; LWT was less prevalent than in the two other PICUs, but the patient populations were very different (presence of neonates and many cardiovascular surgery patients). Assessment of the severity of illness at admission and of functional outcome in the survivors are mandatory in future studies.