Increasing Prevalence of Medically Complex Children in US Hospitals

TLDR

The study aimed to assess how hospital admission rates for medically complex children changed over 15 years using national data. Using the Nationwide Inpatient Sample, the authors analyzed 3‑year increments from 1991 to 2005 for children 8 days to 4 years, categorizing discharge diagnoses into nine complex chronic condition groups and examining individual and combined hospitalization rates, including specific trends for cerebral palsy and bronchopulmonary dysplasia. Hospitalization rates for children with multiple complex chronic conditions rose from 83.7 to 166 per 100,000, with significant increases for CP+CCC and BPD+CCC, while CP alone remained stable, indicating a rise in overall medical complexity over 15 years.

Abstract

OBJECTIVE: In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period. PATIENTS AND METHODS: Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined. RESULTS: Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100 000 (1991–1993) to 166 per 100 000 (2003–2005) (P[r] < .001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P = .002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100 000 (P < .001). CONCLUSIONS: Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.