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Epidemiology of childhood death in Australian and New Zealand intensive care units

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Abstract

Purpose

Data on childhood intensive care unit (ICU) deaths are needed to identify changing patterns of intensive care resource utilization. We sought to determine the epidemiology and mode of pediatric ICU deaths in Australia and New Zealand (ANZ).

Methods

This was a retrospective, descriptive study of multicenter data from pediatric and mixed ICUs reported to the ANZ Pediatric Intensive Care Registry and binational Government census. All patients < 16 years admitted to an ICU between 1 January 2006 and 31 December 2016 were included. Primary outcome was ICU mortality. Subject characteristics and trends over time were evaluated.

Results

Of 103,367 ICU admissions, there were 2672 (2.6%) deaths, with 87.6% of deaths occurring in specialized pediatric ICUs. The proportion of ANZ childhood deaths occurring in ICU was 12%, increasing by 43% over the study period. Unadjusted (0.1% per year, 95% CI 0.096–0.104; p < 0.001) and risk-adjusted (0.1%/year, 95% CI 0.07–0.13; p < 0.001) ICU mortality rates fell. Across all admission sources and diagnostic groups, mortality declined except following pre-ICU cardiopulmonary arrest where increased mortality was observed. Half of the deaths followed withdrawal of life-sustaining therapy (51%), remaining constant throughout the study. Deaths despite maximal resuscitation declined (0.92%/year, 95% CI 0.89–0.95%; p < 0.001) and brain death diagnoses increased (0.72%/year, 95% CI 0.69–0.75%; p = 0.001).

Conclusions

Unadjusted and risk-adjusted mortality for children admitted to ANZ ICUs is declining. Half of pediatric ICU deaths follow withdrawal of life-sustaining therapy. Epidemiology and mode of pediatric ICU death are changing. Further investigation at an international level will inform benchmarking, resource allocation and training requirements for pediatric critical care.

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Acknowledgements

The authors would like to thank centers that contribute registry data and the individuals at each center who collect and enter the data, along with staff from the Australian and New Zealand Pediatric Intensive Care Registry (ANZPICR) and the ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE). The Pediatric Study Group (ANZICR PSG) members include: Simon Erickson, Samantha Barr, Perth Children’s Hospital, Perth, Australia; Luregn Schlapbach (Chair), Andreas Schibler, Debbie Long, Jan Alexander (ANZPIC registry), Queensland Children’s Hospital, Brisbane, Australia; Anusha Ganeshalingam, Claire Sherring, Starship Children’s Hospital, Auckland, New Zealand; Gary Williams, Vicky Smith, Sydney Children’s Hospital, Randwick, Australia; Johnny Millar (ANZPIC registry lead), Warwick Butt, Carmel Delzoppo, Royal Children’s Hospital, Melbourne, Australia; Felix Oberender, Monash Children`s Hospital, Melbourne, Australia; Subodh Ganu, Georgia Letton, Women’s and Children’s Hospital, Adelaide, Australia; Marino Festa (Past Chair), Jonathan Egan, Gail Harper, Westmead Children’s Hospital, Sydney, Australia. Statistical support for this study was funded by the Norva Dhalia grant from the College of Intensive Care Medicine (CICM) and resources (statistical analysis and support) were utilized from Boston Children’s Hospital.

Funding

This work was supported by the Norva Dhalia Grant (College of Intensive Care Medicine) to KM. LJS is supported by a Practitioner Fellowship of the National Health and Medical Research Council of Australia and New Zealand, and by the Children`s Hospital Foundation, Brisbane, Australia.

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Authors and Affiliations

  1. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Katie M. Moynihan & Peta M. A. Alexander

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Katie M. Moynihan, Peta M. A. Alexander & Jeffrey P. Burns

  3. Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Australia

    Katie M. Moynihan & Luregn J. Schlapbach

  4. Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, Australia

    Katie M. Moynihan & Luregn J. Schlapbach

  5. Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland

    Luregn J. Schlapbach

  6. Royal Children’s Hospital and Murdoch Children’s Research Institute, Melbourne, Australia

    Johnny Millar & Ben Gelbart

  7. The Children’s Hospital at Westmead, and Sydney Medical School, University of Sydney, Sydney, Australia

    Stephen Jacobe

  8. Sydney Children’s Hospital, Sydney, Australia

    Hari Ravindranathan

  9. Perth Children’s Hospital, Perth, Australia

    Elizabeth J. Croston

  10. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA

    Steven J. Staffa & Jeffrey P. Burns

  11. Department of Paediatrics, University of Melbourne, Melbourne, Australia

    Ben Gelbart

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For the Australian and New Zealand Intensive Care Society Pediatric Study Group (ANZICS PSG) and the ANZICS Centre for Outcome and Resource Evaluation (ANZICS CORE)

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Correspondence to Katie M. Moynihan.

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The authors have not declared any conflict of interest. This work was supported by the Norva Dhalia Grant (College of Intensive Care Medicine) to KM. LJS is supported by a Practitioner Fellowship of the National Health and Medical Research Council of Australia and New Zealand, and by the Children`s Hospital Foundation, Brisbane, Australia.

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Moynihan, K.M., Alexander, P.M.A., Schlapbach, L.J. et al. Epidemiology of childhood death in Australian and New Zealand intensive care units. Intensive Care Med 45, 1262–1271 (2019). https://doi.org/10.1007/s00134-019-05675-1

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