Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?

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dc.contributor.advisorMorrow, Brenda
dc.contributor.advisorRossouw, Beyra
dc.contributor.advisorArgent, Andrew
dc.contributor.authorWege, Martha Helena
dc.date.accessioned2020-11-11T11:45:49Z
dc.date.available2020-11-11T11:45:49Z
dc.date.issued2020
dc.date.updated2020-11-10T09:49:44Z
dc.description.abstractObjectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.
dc.identifier.apacitationWege, M. H. (2020). <i>Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?</i>. (). ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. Retrieved from http://hdl.handle.net/11427/32382en_ZA
dc.identifier.chicagocitationWege, Martha Helena. <i>"Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?."</i> ., ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2020. http://hdl.handle.net/11427/32382en_ZA
dc.identifier.citationWege, M.H. 2020. Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?. . ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. http://hdl.handle.net/11427/32382en_ZA
dc.identifier.ris TY - Master Thesis AU - Wege, Martha Helena AB - Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare. DA - 2020_ DB - OpenUCT DP - University of Cape Town KW - Paediatric Critical Care KW - paediatric intensive care unit KW - death KW - end-of-life KW - mortality KW - mode of death LK - https://open.uct.ac.za PY - 2020 T1 - Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? TI - Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? UR - http://hdl.handle.net/11427/32382 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/32382
dc.identifier.vancouvercitationWege MH. Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?. []. ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2020 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/32382en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Paediatrics and Child Health
dc.publisher.facultyFaculty of Health Sciences
dc.subjectPaediatric Critical Care
dc.subjectpaediatric intensive care unit
dc.subjectdeath
dc.subjectend-of-life
dc.subjectmortality
dc.subjectmode of death
dc.titleWhy, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPhil
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