(380) Mortality Epidemiology in Pediatric Critical Care

Introduction: Mortality rate in the Pediatric Intensive Care Unit (PICU) has been reported as lower than 4% in the United States (USA) . A thesis work in 2017 from data in our PICU reported that mortality was 15% in the 1980’s but with medical technology and evidence-based practices mortality has significantly decreased. ICU utilization remains high since pediatric patient survival has increased. Our study describes the profile of pediatric patients who died in the PICU at a level three pediatric hospital, which may help stablish better resource use in limited situations like the one lived during the pandemic.

Methods: This retrospective study evaluated medical records of patients (0-21 years old) who died during their ICU stay from January 2019 to July 2023. We evaluated patients' demographic, admission diagnosis, cause of death, PICU length of stay (LOS), patients who received Cardiopulmonary Resuscitation (CPR), and autopsies performed.

Results: From a total of 3,656 admissions, 64 (1.8%) died in the PICU. Infants had the highest mortality rate, followed by adolescents. Brain death diagnosis was made in 19 patients. Although there was no statistical difference in PICU LOS between infants and adolescents who died, infants spent more time in the PICU. The most common system affected at admission were respiratory, cardiovascular or neurologic problems. We also describe the prevalence of chronic illness in the mortality group. Most patients did not receive CPR at the time of death.

Conclusions: Mortality rate compares with reports in the USA and other regions of the world. Advances in critical care have allowed to decrease mortality in pediatrics. There are still vulnerable patient populations and risks inherent to patients, not necessarily their care. The low incidence of CPR demonstrates the overall tendency of the modern ICU era of limitation of support in futility situations and good family and team communication in the end-of-life process.