End-of-Life Practices Among Tertiary Care PICUs in the United States. Issue 7 (September 2015)

• Record Type: Journal Article
• Authors: Meert, Kathleen L.; Keele, Linda; Morrison, Wynne; Berg, Robert A.; Dalton, Heidi; Newth, Christopher J. L.; Harrison, Rick; Wessel, David L.; Shanley, Thomas; Carcillo, Joseph; Clark, Amy; Holubkov, Richard; Jenkins, Tammara L.; Doctor, Allan; Dean, J. Michael; Pollack, Murray
• Is Part Of: Pediatric critical care medicine. Volume 16:Issue 7(2015)
• Publication Date: 2015-09
• Subjects: Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000000520
• Languages: English
• ISSNs: 1529-7535

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>To describe variability in end-of-life practices among tertiary care PICUs in the United States.</p> </sec> <sec> <title>Design:</title> <p>Secondary analysis of data prospectively collected from a random sample of patients (<italic>n</italic> = 10, 078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013.</p> </sec> <sec> <title>Setting:</title> <p>Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network.</p> </sec> <sec> <title>Patients:</title> <p>Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay.</p> </sec> <sec> <title>Interventions:</title> <p>None.</p> </sec> <sec> <title>Measurements and Main Results:</title> <p>Two hundred and seventy-five (2.7%; range across sites, 1.3–5.0%) patients died during their hospital stay; of these, 252 (92%; 76–100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47–76%; <italic>p</italic> = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12–46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42–59%), failed cardiopulmonary resuscitation for 53 (19%; 12–28%), limitation of support for 46 (17%; 7–24%), and brain death for 35 (13%; 8–20%); mode of death did not differ across sites (<italic>p</italic> = 0.58). Organ donation was requested from 101 families (37%; 17–88%; <italic>p</italic> < 0.001). Of these, 20 donated (20%; 0–64%). Sixty-two deaths (23%; 10–53%; <italic>p</italic> < 0.001) were medical examiner cases. Of nonmedical examiner cases (<italic>n</italic> = 213), autopsy was requested for 79 (37%; 17–75%; <italic>p</italic> < 0.001). Of autopsies requested, 53 (67%; 50–100%) were performed.</p> </sec> <sec> <title>Conclusions:</title> <p>Most deaths in Collaborative Pediatric Critical Care Research Network–affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.</p> </sec> </abstract>