Epidemiology of Death in a Single PICU over 15 Years
CCCF ePoster library. Sloof N. Nov 8, 2018; 233373
Natalie Sloof
Natalie Sloof
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Abstract
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Introduction/Background

Advances in medicine have significantly reduced but not eliminated pediatric mortality. The majority of pediatric deaths occur within pediatric or neonatal intensive care units following withdrawal of life sustaining treatment (WLST), brain death (BD), failed cardiopulmonary resuscitation (CPR), or limitation of treatment (LT). The increasing availability of pediatric palliative care, provincial legislative changes regarding withholding and withdrawal of life-sustaining treatment, and increasing long-term survival of pediatric patients with chronic, critical illness may influence the distribution of modes of death.

Objectives

To describe mode of death and changes over time as they relate to patient mortality over a 15-year period in a single Canadian pediatric intensive care unit (PICU).

Methods

A retrospective chart review was completed for all patients who died in the PICU at Children’s Hospital – London Health Sciences Centre from January 1, 2003 to December 31, 2017. Demographic data (including sex, age, chronic conditions, reliance on medical technology), admission details (including admission diagnosis, admission source, PELOD severity score, length of stay), and factors surrounding death (including cause of death, mode of death, organ donation, do not resuscitate orders) were collected.

Over the 15-year period, 326 patients were identified. Mortality by year ranged from 1.1% to 4.6%, with a median of 3.2%. Preliminary results showed overall proportions of mode of death were 59.5% WLST, 13.2% BD, 15.0% failed CPR, and 12.3% LT; these trends were fairly consistent over the 15-year period. The three most common causes of death were injury/poisoning (24.8%), infection (13.8%), and congenital (11.0%). Twenty percent of the patients who died in the PICU were dependent on technology prior to PICU admission. Approximately 50% had a significant premorbid condition. Further analyses are pending.

Conclusions

Preliminary analyses indicated that WLST was the most common mode of death. Of the patients in the PICU who died, the proportion that had existing dependence on medical technology has not changed over time. Further investigations with larger patient populations are necessary to elucidate trends in mode of death over time.


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