NO RESUSCITATION ORDERS AND WITHDRAWAL OF THERAPY IN FRENCH PEDIATRICINTENSIVE-CARE UNITS

Objective: To determine the incidence of different modes of death in F rench paediatric intensive care units and to compare patients' charact eristics, including a severity of illness score (Paediatric Risk of Mo rtality: PRISM score) and prior health status (Paediatric Overall Perf ormance Category scale), according to the mode of death. Design: A 4-m onth prospective cohort study. Setting. Nine French multidisciplinary paediatric intensive care units. patients. All patients who died in PI CUs, except premature babies. Main results: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmo nary resuscitation occurred in 26%, do-not-resuscitate status was iden tified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Catego ry were not different between the four groups. Brain-dead patients wer e older than those in whom a do-not-resuscitate order and withdrawal o f therapy were made (median age 81 vs 7 and 4 months). Conclusions: De cisions to limit or to withdraw supportive care were made for a majori ty of patients dying in French paediatric intensive care units. Chroni c health evaluation and severity of illness index are not sufficient t o describe dead-patient populations.