title: Mortality in Spanish pediatric emergency departments: a 5-year multicenter survey.
abstract: BACKGROUND
  Analysis of the causes of death in children in the pediatric emergency department (ED) may aid the development of management and prevention practices.
  
  
  OBJECTIVE
  To identify the causes of death in Spanish pediatric EDs and to analyze the management of these children in the prehospital and hospital settings.
  
  
  METHODS
  This was a retrospective descriptive multicenter survey including all patients whose death was certified in 18 Spanish pediatric EDs between 2008 and 2013.
  
  
  RESULTS
  During the study period, 3 542 426 episodes were registered in the EDs. Of these, 54 patients died (mortality rate: 1.5/100 000 visits). Data of 53 patients are analyzed (male 36, 67%, 31 younger than 2 years old and 43.3% nonpreviously healthy children). The main causes of death were related to their previous illnesses (24.5%), sudden infant death syndrome (20.7%), and traumatism (18.8%).Prehospital cardiopulmonary resuscitation (CPR) was performed in 31 patients, and exclusively by health workers in 19 patients. In 35 patients, the parents witnessed the event and seven began CPR.Thirty children were transferred to the pediatric EDs by medical transport (56.6%) and all of them received prehospital CPR (vs. one patient out of 23 arrived in a nonmedical transportation).In 37 patients, CPR was performed in the pediatric EDs. Overall, CPR lasted 40±23 min (range, 10-120 min). CPR was not performed in seven patients at any time.
  
  
  CONCLUSIONS
  The main causes of death in Spanish pediatric EDs are related to previous illnesses, sudden infant death syndrome, and nonintentional lesions. Several actions have to be considered to improve the quality of care of these children in prehospital and emergency settings.
authors.affiliation: Pediatric Emergency Department, Cruces University Hospital, University of the Basque, Country, Basque Country, Spain.
authors.forename: Edurne
authors.initials: E
authors.lastname: Lopez
authors.forename: June
authors.initials: J
authors.lastname: Udaondo
authors.forename: Mikel
authors.initials: M
authors.lastname: Olabarri
authors.forename: Lorea
authors.initials: L
authors.lastname: Martinez-Indart
authors.forename: Javier
authors.initials: J
authors.lastname: Benito
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
mesh_terms: D002423:Cause of Death; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D018570:Risk Assessment; D013030:Spain