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Limitation of End-of-Life Support Varies Among PICUs

Study finds significant variability; black race, no trainees tied to lower frequency of limitation

WEDNESDAY, Sept. 8 (HealthDay News) -- In the United States, there is significant variability among institutions regarding limitation of end-of-life support for children in pediatric intensive care units (PICUs), with black race and a lack of trainees associated with a lower frequency of limitation decisions, according to research published online Sept. 6 in Pediatrics.

K. Jane Lee, M.D., of the Medical College of Wisconsin in Milwaukee, and colleagues analyzed data on 1,263 deaths in PICUs between January 2004 and September 2005 to describe alterations in end-of-life support across multiple institutions.

The researchers found end-of-life support distribution in the categories of brain death (23 percent), do not resuscitate (16 percent), limitation of support (3 percent), withdrawal of support (46 percent), no limitation (10 percent), and no advance directives (2 percent). Most deaths -- 85 percent -- occurred in the category grouped as "limitation," which included do not resuscitate, limitation of support, and withdrawal of support (brain death was excluded from further analysis). Significant difference existed between institutions, and fewer decisions for limitation were associated with black race and institutions without trainees.

"We found that limitation of support at the end of life for children in PICU settings is more common in the United States now than it was 10 to 15 years ago, occurring for the majority of deaths and in every institution in our cohort. There was significant variability among institutions," the authors write.

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