Journal article
Development of a bedside tool to predict time to death after withdrawal of life-sustaining therapies in infants and children
Pediatric critical care medicine, v 13(4), pp 415-422
01 Jul 2012
PMID: 22067986
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objectives: To generate a preliminary bedside predictor of rapid time-to-death after withdrawal of support in children to help identify potential candidates for organ donation after circulatory death.
Design: Retrospective chart review.
Setting: Pediatric intensive care unit of an academic children's hospital.
Patients: All deaths in the pediatric intensive care unit from May 1996 to April 2007.
Interventions: None.
Measurements and Main Results: Among 1389 deaths, 634 patients underwent withdrawal of support and 518 with complete data regarding demographics, life-supportive therapies, and end-of-life circumstances were analyzed. Three hundred seventy-three (72%) patients died within 30 mins of withdrawal and 452 (87%) died within 60 mins. Using multiple logistic regression, significant predictors of death within 30 or 60 mins (typical cut-off times for organ donation) were identified and a predictor score was generated. Significant predictors included: age 1 month or younger; norepinephrine, epinephrine, or phenylephrine >0.2 mu g/kg/min; extracorporeal membrane oxygenation; and positive end-expiratory pressure >10 cmH(2)O; and spontaneous ventilation. Possible scores for the 30-min predictor ranged from -17 to 67; a score <=-9 predicted a 37% probability of death <= 30 mins, whereas a score >= 38 predicted an 85% probability of death within 30 mins. For the 60-min predictor, scores ranged from -21 to 38; score <=-10 predicted a 59% probability of death within 60 mins and a score >= 16 predicted a 98% probability of death within 60 mins.
Conclusions: This tool is a reasonable preliminary predictor for death within 30 or 60 mins after withdrawal of support in terminally ill or injured children and might assist in identifying potential pediatric candidates for donation after circulatory death, although prospective validation is required. (Pediatr Crit Care Med 2012; 13:415-422)
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Details
- Title
- Development of a bedside tool to predict time to death after withdrawal of life-sustaining therapies in infants and children
- Creators
- Paul M. Shore - Drexel UniversityRong Huang - Drexel UniversityLonnie Roy - Children's Medical Center of DallasCindy Darnell - Children's Medical Center of DallasHeather Grein - The University of Texas Southwestern Medical CenterTammy Robertson - Children's Medical Center of DallasLisa Thompson - Children's Medical Center of Dallas
- Publication Details
- Pediatric critical care medicine, v 13(4), pp 415-422
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Grant note
- 234-2005-370011C / Health Resources and Services Administration; United States Department of Health & Human Services; United States Health Resources & Service Administration (HRSA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000306114300016
- Scopus ID
- 2-s2.0-84864235436
- Other Identifier
- 991019168081504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Critical Care Medicine
- Pediatrics