Forgoing life support: how the decision is made in European pediatric intensive care units

Devictor, Denis; Latour, Jos M.

doi:10.1007/s00134-011-2357-3

Cited by 50 publications

(37 citation statements)

References 40 publications

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“…Why and how ethnicity is associated with differing risk-adjusted PIC mortality warrants further investigation. Aetiology is likely to be complex including, but not limited to, biological polymorphisms, socio-economic status, access to and equity of healthcare provision, lifestyle, diet and varying end-of-life care decisions according to ethnicity and culture [36, 37]. UK reference population anthropometric data largely excludes children of non-white ethnic origin “due to known difference in growth” [22], limiting our ability to interpret weight-for-age in children of non-white ethnicity (Supplementary Appendix 3).…”

Section: Discussionmentioning

confidence: 99%

Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

et al. 2014

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AimsTo determine whether the paediatric intensive care (PIC) population weight distribution differs from the UK reference population and whether weight-for-age at admission is an independent risk factor for mortality.MethodsAdmission weight-for-age standard deviation scores (SDS) were calculated for all PIC admissions (March 2003–December 2011) to Great Ormond Street Hospital: this is the number of standard deviations (SD) between a child’s weight and the UK mean weight-for-age. Categorised into nine SDS groups, standardised mortality ratios (SMR) and logistic regression were used to assess the relationship between weight-for-age at admission and risk-adjusted mortality.ResultsOut of 12,458 admissions, mean weight-for-age was 1.04 SD below the UK reference population mean (p < 0.0001). Based on 942 deaths, risk-adjusted mortality was lowest in those with mild-to-moderately raised weight-for-age (SDS 0.5–2.5) and highest in children with extreme under- or overweight (SDS < −3.5 and SDS > +3.5). Logistic regression indicated that age, gender, ethnicity and weight-for-age are independent risk factors for mortality. South Asian and ‘other’ ethnicities had significantly increased risk of death compared to children of white and black ethnic origin.ConclusionThe PIC population mean weight-for-age is significantly lower than the UK reference mean. The extremes of weight-for-age are over-represented, especially underweight. Weight-for-age at admission is an independent risk factor for mortality. A U-shaped association between weight and risk-adjusted mortality exists, with the lowest risk of death in children who are mild-to-moderately overweight. Future studies should determine the impact of malnutrition on risk-adjusted mortality and investigate the aetiology of risk disparities with ethnicity.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-014-3381-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

et al. 2014

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“…End-of-life practice in UK PICUs has remained fairly typical of the Northern European approach, as demonstrated in the Eurydice studies of ‘Forgoing life-sustaining treatments in children’ 8 9. Most deaths follow withdrawal or limitation of LSTs, rather than failed resuscitation 10.…”

Section: Background Considerationsmentioning

confidence: 99%

Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice:

Larcher

Craig

Bhogal³

et al. 2015

Arch Dis Child

222

206

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“…Some individual NICU nurse researchers are already conducting research in several of these research areas 19–25. They either work nationally or internationally, such as a European study on end-of-life decision making practices supported by ESPNIC or a national study on end-of-life practices in NICU 19 20. Other nurse researchers are active in pain and stress management in neonates 21–23 26–31.…”

Section: Discussionmentioning

confidence: 99%

European neonatal intensive care nursing research priorities: an e-Delphi study

Wielenga

Tume

Latour

et al. 2014

Arch Dis Child Fetal Neonatal Ed

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Forgoing life support: how the decision is made in European pediatric intensive care units

Abstract: The results of this study and comparison with the Eurydice I study (2002) show a trend towards standardization of end-of-life practices across N/W European countries and France in the past decade.

Cited by 50 publications

References 40 publications

Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice:

European neonatal intensive care nursing research priorities: an e-Delphi study

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