Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment.
BACKGROUND
The mortality for children with prolonged stay in pediatric intensive care units (PICU) is much higher than overall mortality. The incidence of withdrawal or limitation of therapy in this group is unknown.


OBJECTIVE
To assess mortality and characteristics of children admitted for >or=28 days to our ICU, and to describe the extent to which limitations of care were involved in the terminal phase preceding death.


METHODS
For the period 2003 to 2005 clinical data were collected retrospectively for children with prolonged stay (defined as >or=28 days) in a medical/surgical PICU of a university children's hospital.


RESULTS
In the PICU, 4.4% of the children (116/2,607, equal gender, mean age 29 days) had a prolonged stay. Median (range) stay was 56 (28-546) days. These children accounted for 3% of total admissions and occupied 63% of total admission days. Mortality during admission for this group was five times higher (22%) than the average PICU mortality rate of 4.6%. Withdrawal or limitation of therapy preceded 70% of deaths.


CONCLUSIONS
Children with prolonged stay in the PICU have a significantly high risk of mortality. Death is typically preceded by limitation of care.
Department of Intensive Care, Erasmus Medical Centre, Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. saranaghib@hotmail.com
Sara
S
Naghib
Cynthia
C
van der Starre
Saskia J
SJ
Gischler
Koen F M
KF
Joosten
Dick
D
Tibboel
D002391:Catchment Area, Health; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D028761:Withholding Treatment / Q000706:statistics & numerical data*