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Significant rise in proportion of chronically ill children dying in intensive care
May 01, 2007Characteristics of deaths occurring in hospitalized children -- changing trends
The proportion of chronically ill young children dying in intensive care after being admitted to other hospital wards has steadily risen year on year since the end of the 1990s, reveals a study in the Journal of Medical Ethics.
The researchers analysed the records of one large children's hospital, to find out where children had died, and of what causes.
The period of analysis spanned seven years from 1997 to 2004 and included all age groups from 0 to 18 years.
During the seven years, 1127 children died, over half of whom (58%) were younger than 12 months.
Congenital malformations, perinatal disease, cardiovascular disorders, and cancers formed the bulk of the causes of death.
There were no major changes to overall admission rates to the hospital or to intensive care over the study period, nor did overall death rates vary.
But the numbers of children dying in intensive care rose from around 80% in 1997 to almost 91% in 2004.
Among children who died in intensive care, the numbers of those who had been admitted from wards within the hospital almost doubled over the same period from just under 15% to 25%.
Children spent almost two weeks elsewhere before admission to intensive care.
Infants with congenital problems or perinatal disease were more than twice as likely to die in intensive care, while older children with cancer were more than six times as likely to die in other hospital wards. .
The authors say that guidance from the Royal College of Paediatrics and Child Health, published in 1997, specifies what sorts of conditions merit withdrawing of life support or active treatment.
But the rising numbers of children dying in intensive care suggests that it is not being followed and that terminally ill children are still being actively treated.
This might be because the course of acute bouts of illness in children with chronic problems may not always be clear, suggest the authors.
"It is equally possible that parental and societal expectations regarding children's good health and long life spans prompts them to seek aggressive curative care despite the benefits of such a course being unclear," they say.
But they conclude that death in intensive care is a highly distressing experience for both the child and parents and that early involvement of a symptom care team could be helpful.
BMJ Specialty Journals
The period of analysis spanned seven years from 1997 to 2004 and included all age groups from 0 to 18 years.
During the seven years, 1127 children died, over half of whom (58%) were younger than 12 months.
Congenital malformations, perinatal disease, cardiovascular disorders, and cancers formed the bulk of the causes of death.
There were no major changes to overall admission rates to the hospital or to intensive care over the study period, nor did overall death rates vary.
But the numbers of children dying in intensive care rose from around 80% in 1997 to almost 91% in 2004.
Among children who died in intensive care, the numbers of those who had been admitted from wards within the hospital almost doubled over the same period from just under 15% to 25%.
Children spent almost two weeks elsewhere before admission to intensive care.
Infants with congenital problems or perinatal disease were more than twice as likely to die in intensive care, while older children with cancer were more than six times as likely to die in other hospital wards. .
The authors say that guidance from the Royal College of Paediatrics and Child Health, published in 1997, specifies what sorts of conditions merit withdrawing of life support or active treatment.
But the rising numbers of children dying in intensive care suggests that it is not being followed and that terminally ill children are still being actively treated.
This might be because the course of acute bouts of illness in children with chronic problems may not always be clear, suggest the authors.
"It is equally possible that parental and societal expectations regarding children's good health and long life spans prompts them to seek aggressive curative care despite the benefits of such a course being unclear," they say.
But they conclude that death in intensive care is a highly distressing experience for both the child and parents and that early involvement of a symptom care team could be helpful.
BMJ Specialty Journals
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Initial Results Show Pregnant Women Mount Strong Immune Response To One Dose of 2009 H1N1 Flu Vaccine
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Muscle weakness a common side effect of long stays in intensive care units
After decades of focusing on the management of respiratory failure, circulatory shock and severe infections that lead to extended stays in hospital intensive care units, critical care researchers are increasingly turning attention to what they believe is a treatable complication developed by many who spend days or weeks confined to an ICU bed: debilitating muscle weakness that can linger long after hospital discharge.
Stanford study recommends change in treating pulmonary embolisms
William Kuo, MD, was the on-call interventional radiologist one Friday night three years ago when he received a call from the intensive care unit at Stanford Hospital & Clinics.
Treating ROP in tiny preemies; better glaucoma follow-up in urban clinic
Highlights of today's Scientific Program of the 2009 American Academy of Ophthalmology (AAO) - Pan-American Association of Ophthalmology (PAAO) Joint Meeting include: John T. Flynn, MD, Columbia University School of Medicine, discussing the ever-tougher challenges Eye M.D.s face in caring for the vision of the tiniest premature babies; and a report by Bradford W. Lee, MD, Stanford University School of Medicine, on barriers to glaucoma follow-up as perceived by patients in an urban, culturally diverse clinic.
Patients in US 5 times more likely to spend last days in ICU than patients in England
Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England.
U-M researchers find those with severe H1N1 at risk for pulmonary emboli
University of Michigan researchers have found that patients with severe cases of the H1N1 virus are at risk for developing severe complications, including pulmonary emboli, according to a study published today in the American Journal of Roentgenology.
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