Epidemiology of Death in the PICU at Five U.S. Teaching Hospitals*

Abstract

Objective To determine the epidemiology of death in pediatric intensive care units (PICUs) at 5 geographically diverse teaching hospitals across the United States. Design, Setting, and Patients In the PICUs of five teaching hospitals across the United States, we prospectively identified 192 consecutive patients who died prior to PICU discharge. Each site enrolled between 24 and 50 patients. Each PICU had similar organizational and staffing structures. Interventions None Measurements and Main Results The overall mortality rate was 2.39% (range 1.85% to 3.38%). 133 (70%) patients died following the withholding or withdrawal of life-sustaining treatments, 30 (16%) were diagnosed as brain dead, and 26 (14%) died following an unsuccessful resuscitation attempt. Fifty-seven percent of all deaths occurred within the first week of admission;these patients, who were more likely to have new onset illnesses or injuries, included the majority of those who died following unsuccessful CPR attempts or brain death diagnoses. Patients who died beyond one week length-of-stay in the PICU were more likely to have pre-existing diagnoses, to be technology dependent prior to admission, and to have died following the withdrawal of life-sustaining treatment. Only 64% of the patients who died following the withholding or withdrawing of life support had a formal DNR order in place at the time of their death. Conclusions The mode of death in the PICU is proportionally similar to that reported over the past two decades, while the mortality rate has nearly halved. Death is largely characterized by two fairly distinct profiles that are associated with whether death occurs within or beyond one week length-of-stay. Decisions not to resuscitate are often made in the absence of a formal DNR order. These data have implications for future quality improvement initiatives, especially around palliative care, end-of-life decision making, and organ donation.

Brain death and organ donation in Argentine pediatric intensive care units. A multicenter study

“…The incidence of certified BD (N = 103) at the 7 PICUs that participated in the study was 1% of all admissions, which accounted for 13.4% of mortality, similar to the values observed in other international studies 3,9 and in a multicenter study conducted in Argentina that included 16 PICUs and determined that BD accounted for 11% of deaths (52 out of 448).…”

“…2 The incidence of BD at the PICU accounts for approximately 16% of deaths. 3,4 The most common cause of BD is trauma. 5 In the field of pediatrics, the need for solid organ donations has increased worldwide.…”

Family Experience and PICU Death: A Meta-Synthesis

“…7,8 Research from Australia, 4,5,9 the United States, 10,11 and the United Kingdom 1 has found that children most frequently die as a result of withdrawal of life support, whereas studies from Brazil, 3 France, and Eastern and Central Europe 2 identify that most children die in PICUs as a result of failed cardiopulmonary resuscitation. Some have argued that this can be attributed largely to cultural differences related to end-oflife care practices and the social acceptance of the death of a child.…”

Muerte encefálica y donación de órganos en unidades de cuidados intensivos pediátricos de Argentina. Estudio multicéntrico

“…2 La incidencia de ME en las UTIP es de alrededor del 16% de las muertes. 3,4 La causa más frecuente son los traumatismos. 5 En el ámbito pediátrico, existe, a nivel mundial, un incremento en la necesidad de donación de órganos sólidos.…”