title: Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country.
abstract: OBJECTIVE
  Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.
  
  
  METHODS
  Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012.
  
  
  RESULTS
  A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period.
  
  
  CONCLUSIONS
  We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making.
authors: Department of Pediatric and Child Health, Aga Khan University Medical College, Karachi, Pakistan.
authors: Naveed-Ur-Rehman
authors: NU
authors: Siddiqui
authors: Aga Khan University Medical College, Karachi, Pakistan.
authors: Zohaib
authors: Z
authors: Ashraf
authors: Department of Pediatric and Child Health, Aga Khan University Medical College, Karachi, Pakistan.
authors: Humaira
authors: H
authors: Jurair
authors: Department of Pediatric and Child Health, Aga Khan University Medical College, Karachi, Pakistan.
authors: Anwarul
authors: A
authors: Haque
keywords: Brain death; Pediatric Intensive Care Unit; death; do-not-resuscitate; end-of-life care; failed cardiopulmonary resuscitation; withdrawal of care