Abstract P-409: EPIDEMIOLOGY OF DEATH IN PAEDIATRIC INTENSIVE CARE UNITS (PICUS) IN A DEVELOPING COUNTRY

Abstract

Aims & Objectives: Decision making at end of life for children has been the most difficult experience for families and clinician. In depth study in this field is warranted to guide provision, funding and evaluation of palliative and bereavement care for both families and healthcare professionals. To describe the epidemiology of death among tertiary care PICUs in Malaysia. Methods Secondary analysis of prospectively collected data from patients (n=5,277) admitted to PICUs affiliated with the Paediatric Intensive Care Audit Registry (PEDICARE) between August 1, 2008 and December 31, 2015. Patients included were those who died in PICU. Results There were a total of 359 deaths, with crude mortality rate of 6.8% and SMR of 1.13. Ninety-nine (28.4%) patients died following withholding or withdrawal of treatment, 224 (62.4%) died despite maximal support, and 33 (9.2%) died following an unsuccessful resuscitation attempt. Seventy percent of all deaths occurred within the first week of admission. Patients who died beyond one week length-of-stay (LOS) were more likely to be of younger age (infant), cause of death due to liver failure, have prolonged use of mechanical ventilation and inotropes, and to have died following withholding of life-sustaining treatment. Four (26.7%) of brain dead patients died after one week. Conclusions The mode of death varies in relation to heterogeneity of practises and culture across all 3 PICUs. These data have implications for future quality improvement initiatives, especially around palliative care, end-of-life decision making, and organ donation.