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. 2018 Jun;103(6):540-547.
doi: 10.1136/archdischild-2017-312638. Epub 2017 Jul 13.

Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study

Lorna K Fraser  1 , Roger Parslow  2
Affiliations

Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study

Lorna K Fraser et al. Arch Dis Child. 2018 Jun.

Abstract

Objective: To determine how many children are admitted to paediatric intensive care unit (PICU) with life-limiting conditions (LLCs) and their outcomes.

Design: National cohort, data-linkage study.

Setting: PICUs in England.

Patients: Children admitted to a UK PICU (1 January 2004 and 31 March 2015) were identified in the Paediatric Intensive Care Audit Network dataset. Linkage to hospital episodes statistics enabled identification of children with a LLC using an International Classification of Diseases (ICD10) code list.

Main outcome measures: Random-effects logistic regression was undertaken to assess risk of death in PICU. Flexible parametric survival modelling was used to assess survival in the year after discharge.

Results: Overall, 57.6% (n=89 127) of PICU admissions and 72.90% (n=4821) of deaths in PICU were for an individual with a LLC.The crude mortality rate in PICU was 5.4% for those with a LLC and 2.7% of those without a LLC. In the fully adjusted model, children with a LLC were 75% more likely than those without a LLC to die in PICU (OR 1.75 (95% CI 1.64 to 1.87)).Although overall survival to 1 year postdischarge was 96%, children with a LLC were 2.5 times more likely to die in that year than children without a LLC (OR 2.59 (95% CI 2.47 to 2.71)).

Conclusions: Children with a LLC accounted for a large proportion of the PICU population. There is an opportunity to integrate specialist paediatric palliative care services with paediatric critical care to enable choice around place of care for these children and families.

Keywords: Child; Life-Limiting Conditions; PICU; Palliative Care; Survival.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flowchart. HES, Hospital Episodes Statistics; LLC, life-limiting condition; PICU, paediatric intensive care unit.
Figure 2
Figure 2
Survival curves with 95% CIs. LLC, life-limiting condition; PICU, paediatric intensive care unit.
See this image and copyright information in PMC

Comment in

References

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