title: Characteristics of deaths in paediatric intensive care: a 10-year study.
abstract: OBJECTIVE
  To describe the patient mortality over a 10-year period in a paediatric intensive care unit (PICU) including patient demographics, length of stay, cause and mode of death and to compare these findings with pre-existing literature from the western world.
  
  
  METHODS
  A retrospective chart review.
  
  
  METHODS
  A UK tertiary PICU.
  
  
  METHODS
  All children who died in the PICU over a 10-year period between 1 November 1997 and 31 October 2007 (n = 204).
  
  
  METHODS
  None.
  
  
  RESULTS
  Data recorded for each patient included patient demographics, length of stay and cause of death according to the International Classification of Disease-10 classification, and mode of death. Mode of death was assigned for each patient by placement in one of four categories: (i) brain death (BD), (ii) managed withdrawal of life-sustaining medical therapy (MWLSMT), (iii) failed cardiopulmonary resuscitation (CPR) and (iv) limitation of treatment (LT). Over the study period, findings showed a median length of stay of 2 days (IQR 0-5 days), with a mortality rate of 5%. The most common mode of death was MWLSMT (n = 112, 54.9%) and this was consistent across the 10-year period. Linear regression analysis demonstrated no significant change in trend over the 10 years in each of the modes of death; BD (p = 0.84), MWLSMT (p = 0.88), CPR (p = 0.35) and LT (p = 0.67).
  
  
  CONCLUSIONS
  End-of-life care is an important facet of paediatric intensive nursing/medicine. Ten years on from the Royal College of Paediatrics and Child Health publication 'Withholding or withdrawing life sustaining treatment in children: A framework for practice', this study found managed withdrawal of MWLSMT to be the most commonly practised mode of death in a tertiary PICU, and this was consistent over the study period.
authors.affiliation: MRCPCH, Paediatric Specialist Registrar, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Derby Road, Nottingham, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sands
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Manning
authors.forename: Harish
authors.initials: H
authors.lastname: Vyas
authors.forename: Asrar
authors.initials: A
authors.lastname: Rashid
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001926:Brain Death / Q000175:diagnosis; D016887:Cardiopulmonary Resuscitation / Q000639:trends; D002423:Cause of Death / Q000639:trends; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000639:trends; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000639:trends*; D038801:International Classification of Diseases / Q000639:trends; D007902:Length of Stay / Q000639:trends; D016014:Linear Models; D008297:Male; D008485:Medical Audit; D010343:Patient Admission / Q000639:trends; D012189:Retrospective Studies; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013727:Terminal Care / Q000639:trends; D017211:Treatment Failure; D028761:Withholding Treatment / Q000639:trends