Epidemiology of pediatric death in australian and New Zealand intensive care units

Abstract

Aims & Objectives: We sought to determine the epidemiology of pediatric deaths in intensive care units (ICUs) in Australasia. Methods We identified children (<16 years) with ICU admission between 01/01/2006 and 31/12/2016 from the Australian and New Zealand Pediatric Intensive Care Registry. The primary outcome was ICU mortality. We compared characteristics between decedents and survivors, and mode of death, ICU length of stay (LOS)>7days, presence of a comorbidity and recent ICU admission in decedents. Results Of 103367 admissions there were 2672 (2.6%) ICU deaths; 87.6% occurred in pediatric ICUs. Over the study period overall ICU mortality rate fell (0.1%/year, p<0.005) while total deaths remained unchanged (p=0.445). ICU deaths represented 12% of total Australasian paediatric deaths. Compared with survivors, decedents were more likely to have a comorbidity (OR 1.4[1.3-1.5], p<0.001) and ICU LOS>7days (OR 4.1 [3.8-4.5], p<0.001). Half of all deaths followed withdrawal of life-sustaining therapy (WLST). While the proportion of deaths with WLST remained unchanged, those with maximal resuscitation declined (0.91%/year, p<0.005) while brain death diagnoses increased (0.71%/year, p<0.005). The proportion of decedents with a comorbidity or previous ICU admission rose (0.68%/year and 0.85%/year respectively, p<0.05) both with longer ICU LOS prior to death (median 3 and 2.2days respectively,p<0.001). ICU LOS>7days was 5.7 times more likely in decedents with a comorbidity and twice as likely in ICU readmissions (p<0.001). Conclusions The ICU mortality rate for Australasian children is declining. Death most commonly follows WLST. An increasing proportion of decedents have comorbidities or previous ICU admissions, and these patients take up significant ICU days prior to death.L6238157782018-09-13 <br />