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JOURNAL ARTICLE
MULTICENTER STUDY
No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d'Urgences Pédiatriques.
Acta Paediatrica 1998 July
OBJECTIVE: To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death.
DESIGN: A 4-month prospective cohort study.
SETTING: Nine French multidisciplinary paediatric intensive care units.
PATIENTS: All patients who died in PICUs, except premature babies.
MAIN RESULTS: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months).
CONCLUSIONS: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.
DESIGN: A 4-month prospective cohort study.
SETTING: Nine French multidisciplinary paediatric intensive care units.
PATIENTS: All patients who died in PICUs, except premature babies.
MAIN RESULTS: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do-not-resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain-dead patients were older than those in whom a do-not-resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months).
CONCLUSIONS: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.
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