Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Intensive Care Med. 2019 Sep;45(9):1262-1271. doi: 10.1007/s00134-019-05675-1. Epub 2019 Jul 3.
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).
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.
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).
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.
需要了解儿童重症监护病房（ICU）死亡的数据，以确定重症监护资源利用模式的变化。我们旨在确定澳大利亚和新西兰（ANZ）儿科 ICU 死亡的流行病学和模式。
这是一项对儿科和混合 ICU 多中心数据的回顾性描述性研究，这些数据来自于向 ANZ 儿科重症监护登记处和两国政府普查报告的。纳入了 2006 年 1 月 1 日至 2016 年 12 月 31 日期间入住 ICU 的所有<16 岁的患者。主要结局是 ICU 死亡率。评估了患者特征和随时间的趋势。
在 103367 例 ICU 入住患者中，有 2672 例（2.6%）死亡，其中 87.6%的死亡发生在专门的儿科 ICU。ANZ 儿童 ICU 死亡率为 12%，在研究期间增加了 43%。未调整（每年 0.1%，95%CI 0.096-0.104；p<0.001）和风险调整（每年 0.1%，95%CI 0.07-0.13；p<0.001）的 ICU 死亡率均下降。在所有入院来源和诊断组中，除 ICU 前心肺骤停外，死亡率均下降，在 ICU 前心肺骤停中观察到死亡率增加。一半的死亡是在停止维持生命的治疗后（51%），整个研究期间保持不变。尽管进行了最大程度的复苏，但死亡率仍在下降（每年 0.92%，95%CI 0.89-0.95%；p<0.001），脑死亡诊断增加（每年 0.72%，95%CI 0.69-0.75%；p=0.001）。
ANZ ICU 收治儿童的未调整和风险调整死亡率正在下降。一半的儿科 ICU 死亡是在停止维持生命的治疗后。儿科 ICU 死亡的流行病学和模式正在发生变化。在国际层面进一步调查将为儿科危重病护理的基准制定、资源分配和培训要求提供信息。
