Futility and inappropriate care in pediatric intensive care: a cross-sectional survey.
BACKGROUND
Over recent years, there have been increasing concerns regarding an increase in the number of futile and inappropriate admissions to pediatric intensive care units (PICUs) in the United Kingdom (UK).


METHODS
A prospective cross-sectional survey was carried out using a data collection form distributed by mail to the directors of all PICUs in the UK. Respondents were asked to give details of all patients on their unit on a specific day including age, reason for admission and any preexisting medical conditions. An assessment was made by respondents of whether the care being provided in each case was, in their opinion, appropriate, futile or inappropriate according to standard definitions.


RESULTS
We received responses from 21 units (68%) who reported the details of 111 patients. Care was felt to be appropriate in 88 of these cases (79%), futile in nine cases (8%) and inappropriate in 14 cases (13%). Futile cases were most commonly admitted with respiratory failure and all had preexisting medical conditions, most commonly developmental delay. Where care was felt to be inappropriate, respiratory failure was again the most common reason for admission and all had a preexisting medical condition, most commonly cardiovascular disease.


CONCLUSIONS
The care being provided in 21% of the PICU cases, described in this study, was felt to be either futile or inappropriate by the directors of those units. There is an urgent need to, accurately, establish the resource consumption associated with these patients and to establish a standard approach to futility and inappropriate care in PICU in the UK.
Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK.
Gopi
G
Vemuri
Stephen Derek
SD
Playfor
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003430:Cross-Sectional Studies; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D018447:Medical Futility; D010343:Patient Admission / Q000706:statistics & numerical data; D006113:United Kingdom