Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country

Abstract

Background and Aim: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.Materials and 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.Conclusion: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.

End-of-life care in the Pediatric Intensive Care Units: Challenges and ethical principles

“…Similar to previous reports, the majority of deaths in the accompanying study[ 1 ] occurred following limitation of life-sustaining treatments (including “do not resuscitate” orders and “withdrawal of life-support treatment”). [ 3 ] The reader is left to interpret the meaning of “life-support treatment.” This could include any or all of nutritional support, antibiotic treatment, mechanical ventilation, inotropes, fluid therapy, etc.…”

“…present a report on the mortality patterns in Pediatric Intensive Care Units (PICU) in Pakistan, a developing country. [ 1 ] It is difficult to interpret the apparently high mortality rate of almost 13% without the context of average predicted mortality on admission (i.e. standardized mortality rates [SMR]).…”

“… It is unclear which categories were most prevalent in the study by Siddiqui, et al . [ 1 ] Importantly, the decision to withhold or withdraw life-sustaining treatment should never be seen as an end in itself. While the goals of care change; for example to ease suffering, reduce pain, and promote comfort; holistic, multidisciplinary care of the child and their family should never stop.…”

<p>Pediatricians’ Perceptions Toward Do Not Resuscitate: A Survey in Saudi Arabia and Literature Review</p>

“…12 Similarly, several international studies (from the US, UK, France, and Pakistan) reported that up to 60% of all deaths in PICUs were attributable to DNR orders. [23][24][25][26] Different numbers were reported by Devictor and Nguyen 27 (survey of 12 PICUs from northern Europe and 27 from southern Europe), where the decision to forgo life-sustaining treatment was more often made in PICUs in northern European countries than in southern ones (47% vs 30%, P=0.02). A much higher percentage was reported by Moore et al: 28 74% of deaths in an Australian children's hospital ICU followed the withdrawal and limitation of life-sustaining treatment.…”

Nosocomial Bloodstream Infections in Children in Intensive Care Unit: Organisms, Sources, Their Sensitivity Pattern and Outcome of Treatment

“…3 Crude mortality rate of children (median age 2.8 years) in a pediatric ICU was shown 12.9%. 28 Ahmed et al 12 showed, crude mortality rate with bloodstream infections in ICU was 38%. .Our study found 26.1% fatal outcome of children from ICU acquired bloodstream infection.…”