Deaths in a paediatric intensive care unit: A review over three years.

Background: Deaths in paediatric intensive care units (PICUs) are sometimes unavoidable. The decision to withdraw or withhold treatment is important especially in places where there are limited resources. Objective: To evaluate the modes of death and underlying diseases of patients’ deaths in a PICU. Method: We retrospectively reviewed the clinical features and management of consecutive non-survivors in the PICU at a tertiary care University Hospital in a developing country over a three-year period. Results: Of 1,389 admissions, 110 (8%) patients died. The median age of the deaths was 4.1 years. Most (86%) patients had underlying diseases including congenital heart diseases (27%) and malignancies (23%). Forty-seven patients died with active treatment (AT), 60 died with life support limitation (LSL), and 3 had brain death (BD). The median length of stay (LOS) in AT group was 3 days and this was not significantly different (p=0.056) from the median LOS in LSL group which was 5 days. LOS less than 3 days, postoperative cases and underlying diseases of the cardiovascular system were factors associated with the AT group. The three common complications leading to death were multi-organ failure, septicaemia with septic shock and respiratory failure. Conclusions: Congenital heart diseases and malignancies were the two common underlying diseases found in non-survivors. LSL was the common mode of death in PICU.

Evaluation of errors and its etiological relevance with variables associated with death certificate.

Tendency to commit serious & trivial errors while certifying death still looms large. So some one may say, there is only one certificate in the world which is full of errors and that is death certificate! This study is done to evaluate errors in medical & non-medical part and to assess causes of errors of COD. Total 353 death certificates from teaching hospital were evaluated to detect different errors. Causes of errors of COD were scrutinized & confirmed after examining COD statements extensively. 21% death certificates were incompletely written. 99% certificates were incorrectly written. P value of correct & complete certificates with that of incorrect & incomplete certificates was found insignificant. Commonest error was use of ‘with’ instead of ‘due to’ & mention of ‘MOD’ at I a. Causes of these errors (99%) were Lack of training & diagnostic difficulty. Several errors were found in non-medical part which highlight ‘routine attitude’ of certifier. To change this scenario team work is needed. Team of doctors need to certify & supervise death certificates closely. Possibility of legal action against often erring certifying doctor may be appraised publically.