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

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.