title: Validation of a pediatric bedside tool to predict time to death after withdrawal of life support.
abstract: OBJECTIVE
  To evaluate the accuracy of a tool developed to predict timing of death following withdrawal of life support in children.
  
  
  METHODS
  Pertinent variables for all pediatric deaths (age ≤ 21 years) from 1/2009 to 6/2014 in our pediatric intensive care unit (PICU) were extracted through a detailed review of the medical records. As originally described, a recently developed tool that predicts timing of death in children following withdrawal of life support (dallas predictor tool [DPT]) was used to calculate individual scores for each patient. Individual scores were calculated for prediction of death within 30 min (DPT30) and within 60 min (DPT60). For various resulting DPT30 and DPT60 scores, sensitivity, specificity and area under the receiver operating characteristic curve were calculated.
  
  
  RESULTS
  There were 8829 PICU admissions resulting in 132 (1.5%) deaths. Death followed withdrawal of life support in 70 patients (53%). After excluding subjects with insufficient data to calculate DPT scores, 62 subjects were analyzed. Average age of patients was 5.3 years (SD: 6.9), median time to death after withdrawal of life support was 25 min (range; 7 min to 16 h 54 min). Respiratory failure, shock and sepsis were the most common diagnoses. Thirty-seven patients (59.6%) died within 30 min of withdrawal of life support and 52 (83.8%) died within 60 min. DPT30 scores ranged from -17 to 16. A DPT30 score ≥ -3 was most predictive of death within that time period, with sensitivity = 0.76, specificity = 0.52, AUC = 0.69 and an overall classification accuracy = 66.1%. DPT60 scores ranged from -21 to 28. A DPT60 score ≥ -9 was most predictive of death within that time period, with sensitivity = 0.75, specificity = 0.80, AUC = 0.85 and an overall classification accuracy = 75.8%.
  
  
  CONCLUSIONS
  In this external cohort, the DPT is clinically relevant in predicting time from withdrawal of life support to death. In our patients, the DPT is more useful in predicting death within 60 min of withdrawal of life support than within 30 min. Furthermore, our analysis suggests optimal cut-off scores. Additional calibration and modifications of this important tool could help guide the intensive care team and families considering DCD.
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: Ashima
authors: A
authors: Das
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: Ingrid M
authors: IM
authors: Anderson
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: David G
authors: DG
authors: Speicher
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: Richard H
authors: RH
authors: Speicher
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: Steven L
authors: SL
authors: Shein
authors: Ashima Das, Ingrid M Anderson, David G Speicher, Richard H Speicher, Steven L Shein, Alexandre T Rotta, Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, United States.
authors: Alexandre T
authors: AT
authors: Rotta
keywords: Children; Death; Donation after circulatory death; Organ donation