Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Pediatr Crit Care Med. 2011 Sep;12(5):566-71. doi: 10.1097/PCC.0b013e3181fe3420.
Mortality rates from critical illness in children have declined over the past several decades, now averaging between 2% and 5% in most pediatric intensive care units. Although these rates, and mortality rates from specific disorders, are widely understood, the impact of acute neurologic injuries in such children who die and the role of these injuries in the cause of death are not well understood. We hypothesized that neurologic injuries are an important cause of death in children.
Retrospective review.
Pediatric intensive care unit at Children's Hospital of Pittsburgh, an academic tertiary care center.
Seventy-eight children who died within the pediatric intensive care unit from April 2006 to February 2008.
None.
Data regarding admission diagnosis, presence of chronic illness, diagnosis of brain injury, and cause of death were collected. Mortality was attributed to brain injury in 65.4% (51 of 78) of deaths. Ninety-six percent (28 of 29) of previously healthy children died with brain injuries compared with 46.9% (23 of 49) of chronically ill children (p < .05). The diagnosed brain injury was the proximate cause of death in 89.3% of previously healthy children and 91.3% with chronic illnesses. Pediatric intensive care unit and hospital length of stay was longer in those with chronic illnesses (38.8 ± 7.0 days vs. 8.9 ± 3.7 days and 49.2 ± 8.3 days vs. 9.0 ± 3.8 days, p < .05 and p < .001, respectively).
Brain injury was exceedingly common in children who died in our pediatric intensive care unit and was the proximate cause of death in a large majority of cases. Neuroprotective measures for a wide variety of admission diagnoses and initiatives directed to prevention or treatment of brain injury are likely to attain further improvements in mortality in previously healthy children in the modern pediatric intensive care unit.
在过去几十年中，儿童重症疾病的死亡率有所下降，目前大多数儿科重症监护病房的死亡率平均在 2%至 5%之间。尽管这些死亡率以及特定疾病的死亡率被广泛了解，但在死亡的此类儿童中，急性神经损伤的影响以及这些损伤在死因中的作用尚不清楚。我们假设神经损伤是儿童死亡的重要原因。
回顾性研究。
匹兹堡儿童医院儿科重症监护病房，这是一家学术性的三级护理中心。
2006 年 4 月至 2008 年 2 月期间在儿科重症监护病房死亡的 78 名儿童。
无。
收集了有关入院诊断、慢性疾病存在情况、脑损伤诊断和死因的数据。死亡归因于脑损伤的占 65.4%（78 例死亡中的 51 例）。96%（28 例）无既往病史的健康儿童死亡时伴有脑损伤，而 46.9%（49 例慢性疾病儿童）伴有脑损伤（p<.05）。89.3%无既往病史的健康儿童和 91.3%的患有慢性疾病的儿童，其诊断的脑损伤是直接死因。患有慢性疾病的儿童的儿科重症监护病房和医院住院时间较长（38.8 ± 7.0 天与 8.9 ± 3.7 天，49.2 ± 8.3 天与 9.0 ± 3.8 天，p<.05 和 p<.001）。
在我们的儿科重症监护病房中，死亡的儿童中脑损伤极其常见，且在大多数情况下是直接死因。对于广泛的入院诊断，采取神经保护措施并采取预防或治疗脑损伤的措施，可能会使现代儿科重症监护病房中健康儿童的死亡率进一步降低。
