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Is it taking longer to die in paediatric intensive care in England and Wales?
  1. Adrian Plunkett1,
  2. Roger C Parslow2
  1. 1Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, UK
  2. 2Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Dr Roger C Parslow, Leeds Institute of Cardiovascular and Metabolic Medicine, Room 8.49, Worsley Building, Clarendon Way, University of Leeds, Leeds LS2 9JT, UK; r.c.parslow{at}leeds.ac.uk

Abstract

Introduction All-cause infant and childhood mortality has decreased in the UK over the last 30 years. Advances in paediatric critical care have increased survival in paediatric intensive care units (PICUs) but may have affected how and when children die in PICU. We explored factors affecting length of stay (LOS) of children who died in PICU over an 11-year period.

Methods We analysed demographic and clinical data of 165 473 admissions to PICUs in England and Wales, from January 2003 to December 2013. We assessed time trends in LOS for survivors and non-survivors and explored the effect of demographic and clinical characteristics on LOS for non-survivors.

Results LOS increased 0.310 days per year in non-survivors (95% CI 0.169 to 0.449) and 0.064 days per year in survivors (95% CI 0.046 to 0.083). The proportion of early deaths (<24 h of admission) fell 0.44% points per year (95% CI −0.971 to 0.094), but the proportion of late deaths (>28 days of PICU stay) increased by 0.44% points per year (95% CI 0.185 to 0.691). The paediatric index of mortality score in early deaths increased by 0.77% points per year (95% CI 0.31% to 1.23%).

Discussion Increased LOS in children who die in PICU is driven by a decreased proportion of early deaths and an increased proportion of late deaths. This trend, combined with an increase in the severity of illness in early deaths, is consistent with a reduction in early mortality for acutely ill children, but a prolongation of life for those children admitted to PICU with life-limiting illnesses.

  • Mortality
  • Intensive Care
  • Outcomes research

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