Pediatric Critical Care Resource Use by Children with Medical Complexity

Abstract

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.

Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System

“…All of these factors, with the exception of being identified as being in cardiogenic shock, were associated with increased LOS and greater costs on univariable analysis. This is consistent with what has been described in other populations where chronic conditions, disease severity, and postoperative complications have all been associated with high resource utilization …”

“…This is consistent with what has been described in other populations where chronic conditions, disease severity, and postoperative Continued complications have all been associated with high resource utilization. [28][29][30][31][32][33] On multivariable analysis, several patient factors were associated with hospital LOS and/or total costs including age, being on ECMO, being intubated, having prior cardiac surgery, higher volume of VADs implanted, and the number of chronic complex conditions. Importantly, in controlling for baseline characteristics, there was no difference in resource utilization based on device type, underlying disease, and postoperative adverse events.…”

End-of-Life and Bereavement Care in Pediatric Intensive Care Units

“…11 Despite unintentional injuries being the leading overall cause of death in children over one year, most deaths in the PICU are associated with a pre-existing or chronic condition. 11 Given recent data that suggest over half of the children admitted to a PICU have a chronic, complex medical condition 17 , this finding may merely reflect the population of patients currently being cared for in the PICU. Independent of the reasons, the findings that children with chronic conditions account for a large proportion of both the admissions to and the deaths within a PICU, may have significant implications for the provision of palliative care within that setting.…”

Emergency department risk factors for serious clinical deterioration in a paediatric hospital in Peru

“…Interestingly, although cases were more likely to have a co‐morbidity, this variable did not retain significance when incorporated into our multivariate model. This is surprising, especially in light of a recent study showing that patients with complex chronic medical conditions consumed over 75% of PICU resources . This could be because we did not subcategorize co‐morbidities according to chronicity or complexity, which gives conditions like asthma and cerebral palsy equal weight.…”

“…This is surprising, especially in light of a recent study showing that patients with complex chronic medical conditions consumed over 75% of PICU resources. 29 This could be because we did not subcategorize co-morbidities according to chronicity or complexity, which gives conditions like asthma and cerebral palsy equal weight. In addition, given INSN's tertiary care setting, a higher proportion of patients presenting to this institution have co-morbidities, making an association with SCD less likely to be detected.…”