Validation of a pediatric bedside tool to predict time to death after withdrawal of life support

Das, Ashima; Anderson, Ingrid; Speicher, David; Speicher, Richard; Shein, Steven L.; Rotta, Alexandre T.

doi:10.5409/wjcp.v5.i1.89

Cited by 9 publications

(22 citation statements)

References 11 publications

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“…In two external cohorts, the Dallas models did not achieve the predictive performance reported in the original study (16,17). Further, the optimal cutoff scores in the Das et al (17) validation differed considerably from the original study, which makes the tool impossible to use universally without further calibration and modification. The Winter et al (16) study assessed the Dallas model and also reported lower performance metrics than the original study.…”

Section: Limitationsmentioning

confidence: 81%

“…In the Das et al (17) validation study of the Dallas models, sensitivity and specificity were lower than that reported by Shore et al (24). The authors identified that the Dallas 30-minute tool had the best performance at a score of greater than or equal to 3 (sensitivity, 0.76 and specificity, 0.52); the Dallas 60-minute tool had the best performance at a score of greater than or equal to 9 (sensitivity, 0.75 and specificity.…”

Section: Model Assessmentmentioning

confidence: 99%

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Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children

Winter

Ledbetter²

2022

Critical Care Explorations

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OBJECTIVES:Accurately predicting time to death after withdrawal of life-sustaining treatment is valuable for family counseling and for identifying candidates for organ donation after cardiac death. This topic has been well studied in adults, but literature is scant in pediatrics. The purpose of this report is to assess the performance and clinical utility of the available tools for predicting time to death after treatment withdrawal in children. DATA SOURCES:Terms related to predicting time to death after treatment withdrawal were searched in PubMed and Embase from 1993 to November 2021. STUDY SELECTION:Studies endeavoring to predict time to death or describe factors related to time to death were included. Articles focusing on perceptions or practices of treatment withdrawal were excluded.DATA EXTRACTION: Titles, abstracts, and full text of articles were screened to determine eligibility. Data extraction was performed manually. Two-by-two tables were reconstructed with available data from each article to compare performance metrics head to head.DATA SYNTHESIS: Three hundred eighteen citations were identified from the initial search, resulting in 22 studies that were retained for full-text review. Among the pediatric studies, predictive models were developed using multiple logistic regression, Cox proportional hazards, and an advanced machine learning algorithm. In each of the original model derivation studies, the models demonstrated a classification accuracy ranging from 75% to 91% and positive predictive value ranging from 0.76 to 0.93. CONCLUSIONS:There are few tools to predict time to death after withdrawal of life-sustaining treatment in children. They are limited by small numbers and incomplete validation. Future work includes utilization of advanced machine learning models.

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Section: Limitationsmentioning

confidence: 81%

Section: Model Assessmentmentioning

confidence: 99%

Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children

Winter

Ledbetter²

2022

Critical Care Explorations

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“…The maximum functional warm recommended ischaemia time is 30 min for the liver and 60 min for the kidneys and lungs in adults; however, the corresponding data in cDCD are still inconclusive 6,8,15 . At present, there are no validated scales for the paediatric population to estimate the likelihood of death after WLST, 24 and there are few published studies on the variables that, in the case of the pediatric donor, predict death in a short time after WLST 25 . In this sense, the prospective study of the dying process in pediatric and neonates is needed, including these patients in studies similar to the one that has been recently published of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned WLST 26 …”

Section: Discussionmentioning

confidence: 99%

“…6,8,15 At present, there are no validated scales for the paediatric population to estimate the likelihood of death after WLST, 24 and there are few published studies on the variables that, in the case of the pediatric donor, predict death in a short time after WLST. 25 In this sense, the prospective study of the dying process in pediatric and neonates is needed, including these patients in studies similar to the one that has been recently published of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned WLST. 26 Second, pediatric donation, especially from neonates, is about family-centered care.…”

Section: Ta B L E 2 Characteristics Of the Infants Who Died After Eol Decisions At 38 Participating Hospitals During The Study Periodmentioning

confidence: 99%

Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs

Caserío

Arnáez²

2021

Pediatric Transplantation

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Background: Organ donation continues to increase worldwide, but in general paediatric patients remain less likely to receive a transplant. The inclusion of neonates as donors after cDCD should be considered in an effort to increase donation rates. Methods:The survey for a cross-sectional national study of potential cDCD neonatal donors (Maastricht type III) was sent to all 90 level III Spanish neonatal units to explore: 1) protocols, education, and specific opinions on donation and 2) potential cDCD that could have been eligible over a 2-year period (2014)(2015).Results: Forty-five centers (50%) completed the survey, and 38/45 gave information about potential eligible donors. In 16% of the centers specific protocols on neonatal donation exist. All hospitals demanded more specific training, and 65% noted that the donation process could be a problem in the family's dismissal of the child.During the study period 46 805 neonates were admitted in the 38 centers, and 625 neonates died. Ninety-five born at a gestational age ≥34 weeks and above 2000 gr died after an EoL decision, 38 (40%) and 13 (14%) of them due to neonatal encephalopathy and multiple congenital anomalies, respectively. There were 31 (33%) elegible infants who died in less than 120 min due to pathologies that did not contraindicate donation.Conclusions: Neonatal cDCD could help to reduce the gap between the supply of and demand for organs according to the potentially eligible patients emerging from this study. Training in EoL and donation processes should be provided to healthcare professionals.

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“…For a patient to become a DCD donor, they must die within a specified amount of time depending on the country, institution, and protocol, with times ranging from 75 seconds up to as much as 20 minutes, although today most protocols in the United States utilize 2-5 minutes. 25,[38][39][40][41][42][43] Although tools to predict timing of death following the withdrawal of support exist, [44][45][46] knowledge of the mechanism of death may aid the pediatric provider in predicting time to death.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pediatric brain‐dead donors to donation after circulatory death donors in the United States

Ghavam

Thompson

Lee

2020

Pediatric Transplantation

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The demand for transplantable organs greatly exceeds the supply in the pediatric population, mainly due to the size restrictions required for successful transplants in these smaller patients and the overall health of the general pediatric population. In current practice, pediatric organ donation occurs via one of two pathways: either after the donor meets criteria for brain death (DBD) or following the process of DCD. A recent large study found that 21% of pediatric patients who died in the PICU were declared braindead and half of those patients went on to be organ donors. 1 In the practice of DCD, donation is offered after a decision to WLST has been made. Reports demonstrate 50% -70% of all children dying in the pediatric intensive care unit died following WLST. 2,3 A recent study demonstrated a pediatric mortality rate of 2.3% in the pediatric intensive care unit, which has halved compared

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Validation of a pediatric bedside tool to predict time to death after withdrawal of life support

Cited by 9 publications

References 11 publications

Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children

Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children

Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs

Comparison of pediatric brain‐dead donors to donation after circulatory death donors in the United States

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