Resumen de Mortalidad infantil en un hospital de nivel terciario.: Limitación de esfuerzo terapéutico, correspondencia clínico-patológica y precisión diagnóstica
E. Alonso Villán, Javier Pérez Rodríguez, José Ignacio Rodríguez González, J.A. Ruiz, María Jesús del Cerro Marín, L. Hierro, A. garcía Pose, Angel Aroca, Ángel Asensio Vegas, Purificación García-Miguel, C. Soto, Juan Ignacio de Diego Sastre, C. Díaz, A. Iglesias, A. Lahoz Tornos, I. Rodríguez
Objective To study infant and child mortality in a third level children's hospital treating highly complex patients.
Patients and methods All children dying in the period 2007- 2009 at La Paz Children's Hospital were evaluated. Epidemiological data, autopsy rate, clinical and autopsy diagnoses and their correspondence and the number of, patients with precise final diagnoses were analysed. Therapeutic effort limitation and palliative care were also evaluated as well as if the final result was expected according to the initial disease or clinical condition of the patients. All the variables were prospectively defined at the start of the study period.
Results A total of 253 cases (6.08 admissions) were analysed. The two leading causes of death were disorders related to prematurity and low birth weight, and haematology oncology malignant diseases. Most patients (87%) died in an intensive care unit (neonatal or paediatric). During the study period 134 autopsies (53%) were performed, and new clinically significant findings were observed in 12 of these (7.8%) but in only one case the treatment could have possibly modified the prognosis (class I discrepancy). Therapeutic effort limitation and palliative care were implemented in 41.9%. Death was initially expected in 83.9% of cases. An accurate final diagnosis was defined in 92%, and the aetiology of the disease was considered to be identified in 86.4% of all deaths.
Conclusions Hospital mortality analysis is useful to evaluate the quality of the paediatric care and to detect adverse results that could be corrected. Paediatric autopsy continues to provide clinically significant data for paediatricians and families. Therapeutic effort limitation and palliative care is increasingly applied in paediatric end of life care. The number of infants and children dying without a final aetiological diagnosis is still considerably high.
