No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d'Urgences Pédiatriques.
OBJECTIVE
To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death.


METHODS
A 4-month prospective cohort study.


METHODS
Nine French multidisciplinary paediatric intensive care units.


METHODS
All patients who died in PICUs, except premature babies.


RESULTS
Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months).


CONCLUSIONS
Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.
Paediatric Intensive Care Unit, CERIM, CH et U Lille, France.
A
A
Martinot
B
B
Grandbastien
S
S
Leteurtre
A
A
Duhamel
F
F
Leclerc
D001926:Brain Death; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005602:France / Q000453:epidemiology; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D008020:Life Support Care; D018447:Medical Futility; D011446:Prospective Studies; D016414:Resuscitation Orders; D020379:Risk Adjustment; D012720:Severity of Illness Index