title: Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.
abstract: OBJECTIVE
  To examine withdrawal and limitation of life-sustaining treatment (WLST) in an Australian paediatric intensive care unit (PICU) and to compare this experience with published data from other countries.
  
  
  METHODS
  Retrospective chart review and literature review.
  
  
  METHODS
  Review of 12 months of patient records from a tertiary Australian children's teaching hospital. Medline search using relevant key words focusing on death and PICU.
  
  
  RESULTS
  Twenty of 27 deaths (74%) followed either WLST (n = 16) or Do Not Resuscitate (DNR) orders (n = 4); five children failed cardiopulmonary resuscitation (CPR); and two children were brain-dead. Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn. The average time between withdrawal of life support and death was 13 min. A review of the English-language literature revealed that 18-65% occurring in PICUs worldwide follow WLST and/or institution of DNR orders. Rates were higher (30-65%) in North America and Europe than elsewhere. Most PICU deaths occurred within 3 days of admission. North American and British parents appear to be involved in decisions regarding withdrawal and limitation of treatment more often than parents in other countries.
  
  
  CONCLUSIONS
  Withdrawal and limitation of life-sustaining treatment was more common in an Australian children's hospital ICU than has been reported from other countries. Details of discussion with parents, including the basis for any decision to WLST, were almost always documented in the patient's medical record.
authors.affiliation: Orange Base Hospital, Orange, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Moore
authors.forename: Ian
authors.initials: I
authors.lastname: Kerridge
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gillis
authors.forename: Stephen
authors.initials: S
authors.lastname: Jacobe
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008485:Medical Audit; D018447:Medical Futility; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care; D028761:Withholding Treatment / Q000706:statistics & numerical data*