Epidemiological analysis of death cases in pediatric intensive care unit of Children′s Hospital of Fudan University

Abstract

Objective To determine the epidemiology of death in PICU in the past ten years. Methods Retrospective cohort study was conducted in the PICU of Children′s Hospital of Fudan University from January 2005 to December 2014. Results The overall mortality rate of PICU was 8.5% over a 10-year period from January 2005 to December 2014.Compared with the period from 2005 to 2009, the mortality rate in PICU decreased from 9.7% to 8.0% during the period of 2010 to 2014.A total of 736 patients died over a 10-year period, including 329(44.7%) infants, 191(26.0%) toddlers, 118(16.0%) preschoolers, and 98(13.3%) school-age and adolescence.From 2005 to 2009, there were 269 deaths, of which 65.4% were infants and toddlers.From 2010 to 2014, there were 467 deaths, of which 73.7% were infants and toddlers.Among the diseases causing death, the severe pneumonia was the most common disease(21.6%), followed by malignant tumors(16.3%), sepsis(15.4%), accidental injury(13.7%), and severe encephalitis(8.0%). In different age groups, the distribution of the diseases causing death was different, such as infants mainly with severe pneumonia(34.3%), toddlers mainly with accidental injury(16.8%), preschoolers mainly with accidental injury and malignant tumors(23.7%), school-age and adolescence mainly with malignant tumor(28.6%). From 2005 to 2009, 77.5% deaths were critically and very critically ill patients, and the sep sis was the most common cause of death(27.6%) especially in very critically ill patients.From 2010 to 2014, 83.0% deaths were critically and very critically ill patients, and the accidental injury was the most common cause of death(23.2%) especially in very critically ill patients, followed by sepsis(17.9%). There were 345 deaths(46.9%) occurred within the first week of admission, mainly with accidental injury(20.9%). There were 391 deaths(53.1%) with the PICU stay for 7 or more days, and severe pneumonia(24.3%) was the most common cause of death.Modes of death were categorized as failed cardiopulmonary resuscitation(54.6%) and forgoing life-sustaining treatment(45.4%). Conclusion Compared with the period from 2005 to 2009, the mortality rate in PICU decreased significantly during the period of 2010 to 2014.The younger the patient, the higher the mortality rate.Most deaths were attributed to severe pneumonia, followed by malignant tumors and sepsis.The causes of death also had relations with severity of diseases and length of PICU stay.Failed cardiopulmonary resuscitation and forgoing life-sustaining treatment were still the most common mode of deaths. Key words: Children; Death; Intensive care units; Cardiopulmonary resuscitation