Pediatric Critical Care Resource Use by Children with Medical Complexity

• Published in: The Journal of pediatrics Vol. 177; pp. 197 - 203.e1
• Main Authors: Chan, Titus, MD, MS, MPP, Rodean, Jonathan, MPP, Richardson, Troy, PhD, Farris, Reid W.D., MD, MS, Bratton, Susan L., MD, MPH, Di Gennaro, Jane L., MD, MS, Simon, Tamara D., MD, MSPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Adolescent; Algorithms; Child; Child, Preschool; chronic diseases; comorbidities; critical care; Critical Care - utilization; Critical Illness - therapy; Cross-Sectional Studies; Female; Health Resources - utilization; Humans; Infant; Infant, Newborn; Intensive Care Units; Male; Pediatrics; PICU; Retrospective Studies; ECMO; Extracorporeal membrane oxygenation; chronic diseases; PHIS; critical care; Noncomplex chronic disease; No chronic disease; Malignancy; PICU; Intensive care unit; NCD; Pediatric Health Information System; NC-CD; comorbidities; C-CD; Complex chronic disease; Malignancy with an additional chronic condition; ICU; PMCA; Pediatric Medical Complexity Algorithm
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2016.06.035

Objectives To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care children's hospitals. Study design This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized. Results Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies. Conclusion Children with medical complexity disproportionately use the majority of ICU resources in children's hospitals. Efforts to improve quality and provide cost-effective care should focus on this population.