Epidemiology of childhood death in Australian and New Zealand intensive care units
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Description
<p>Purpose: Data on childhood intensive care unit (ICU) deaths are needed to identify changing patterns of intensive care resource utilization. We sought to determine the epidemiology and mode of pediatric ICU deaths in Australia and New Zealand (ANZ). Methods: This was a retrospective, descriptive study of multicenter data from pediatric and mixed ICUs reported to the ANZ Pediatric Intensive Care Registry and binational Government census. All patients < 16 years admitted to an ICU between 1 January 2006 and 31 December 2016 were included. Primary outcome was ICU mortality. Subject characteristics and trends over time were evaluated. Results: Of 103,367 ICU admissions, there were 2672 (2.6%) deaths, with 87.6% of deaths occurring in specialized pediatric ICUs. The proportion of ANZ childhood deaths occurring in ICU was 12%, increasing by 43% over the study period. Unadjusted (0.1% per year, 95% CI 0.096–0.104; p < 0.001) and risk-adjusted (0.1%/year, 95% CI 0.07–0.13; p < 0.001) ICU mortality rates fell. Across all admission sources and diagnostic groups, mortality declined except following pre-ICU cardiopulmonary arrest where increased mortality was observed. Half of the deaths followed withdrawal of life-sustaining therapy (51%), remaining constant throughout the study. Deaths despite maximal resuscitation declined (0.92%/year, 95% CI 0.89–0.95%; p < 0.001) and brain death diagnoses increased (0.72%/year, 95% CI 0.69–0.75%; p = 0.001). Conclusions: Unadjusted and risk-adjusted mortality for children admitted to ANZ ICUs is declining. Half of pediatric ICU deaths follow withdrawal of life-sustaining therapy. Epidemiology and mode of pediatric ICU death are changing. Further investigation at an international level will inform benchmarking, resource allocation and training requirements for pediatric critical care.</p>
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| ID Code: | 212017 | ||
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| Item Type: | Contribution to Journal (Journal Article) | ||
| Refereed: | Yes | ||
| ORCID iD: |
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| Measurements or Duration: | 10 pages | ||
| Keywords: | Australia/epidemiology, Cause of Death/trends, Chi-Square Distribution, Child, Child, Preschool, Female, Humans, Infant, Intensive Care Units, Pediatric/organization & administration, Male, New Zealand/epidemiology, Registries/statistics & numerical data, Retrospective Studies, Statistics, Nonparametric | ||
| DOI: | 10.1007/s00134-019-05675-1 | ||
| ISSN: | 0342-4642 | ||
| Pure ID: | 88357453 | ||
| Funding Information: | This work was supported by the Norva Dhalia Grant (College of Intensive Care Medicine) to KM. LJS is supported by a Practitioner Fellowship of the National Health and Medical Research Council of Australia and New Zealand, and by the Children`s Hospital Foundation, Brisbane, Australia. Acknowledgements The authors would like to thank centers that contribute registry data and the individuals at each center who collect and enter the data, along with staff from the Australian and New Zealand Pediatric Intensive Care Registry (ANZPICR) and the ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE). The Pediatric Study Group (ANZICR PSG) members include: Simon Erickson, Samantha Barr, Perth Children’s Hospital, Perth, Australia; Luregn Schlapbach (Chair), Andreas Schibler, Debbie Long, Jan Alexander (ANZPIC registry), Queensland Children’s Hospital, Brisbane, Australia; Anusha Ganeshalingam, Claire Sherring, Starship Children’s Hospital, Auckland, New Zealand; Gary Williams, Vicky Smith, Sydney Children’s Hospital, Randwick, Australia; Johnny Millar (ANZPIC registry lead), Warwick Butt, Carmel Delzoppo, Royal Children’s Hospital, Melbourne, Australia; Felix Oberender, Monash Children`s Hospital, Melbourne, Australia; Subodh Ganu, Georgia Letton, Women’s and Children’s Hospital, Adelaide, Australia; Marino Festa (Past Chair), Jonathan Egan, Gail Harper, Westmead Children’s Hospital, Sydney, Australia. Statistical support for this study was funded by the Norva Dhalia grant from the College of Intensive Care Medicine (CICM) and resources (statistical analysis and support) were utilized from Boston Children’s Hospital. The authors would like to thank centers that contribute registry data and the individuals at each center who collect and enter the data, along with staff from the Australian and New Zealand Pediatric Intensive Care Registry (ANZPICR) and the ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE). The Pediatric Study Group (ANZICR PSG) members include: Simon Erickson, Samantha Barr, Perth Children’s Hospital, Perth, Australia; Luregn Schlapbach (Chair), Andreas Schibler, Debbie Long, Jan Alexander (ANZPIC registry), Queensland Children’s Hospital, Brisbane, Australia; Anusha Ganeshalingam, Claire Sherring, Starship Children’s Hospital, Auckland, New Zealand; Gary Williams, Vicky Smith, Sydney Children’s Hospital, Randwick, Australia; Johnny Millar (ANZPIC registry lead), Warwick Butt, Carmel Delzoppo, Royal Children’s Hospital, Melbourne, Australia; Felix Oberender, Monash Children`s Hospital, Melbourne, Australia; Subodh Ganu, Georgia Letton, Women’s and Children’s Hospital, Adelaide, Australia; Marino Festa (Past Chair), Jonathan Egan, Gail Harper, Westmead Children’s Hospital, Sydney, Australia. Statistical support for this study was funded by the Norva Dhalia grant from the College of Intensive Care Medicine (CICM) and resources (statistical analysis and support) were utilized from Boston Children’s Hospital. | ||
| Copyright Owner: | © 2019 Springer-Verlag GmbH Germany, part of Springer Nature | ||
| Copyright Statement: | This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the document is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recognise and abide by the legal requirements associated with these rights. If you believe that this work infringes copyright please provide details by email to qut.copyright@qut.edu.au | ||
| Deposited On: | 22 Jul 2021 03:37 | ||
| Last Modified: | 19 May 2024 18:30 |
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