Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study.
BACKGROUND
Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.


METHODS
Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.


RESULTS
Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0-13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.


CONCLUSIONS
Technology-dependency is common among children discharged from a children's hospital.
Feudtner
Chris
C
Pediatric Advanced Care Team, Integrated Care Service, and Pediatric Generalist Research Group, The Children's Hospital of Philadelphia, Philadelphia, USA. feudtner@email.chop.edu
Villareale
Nanci Larter
NL
Morray
Barbara
B
Sharp
Virginia
V
Hays
Ross M
RM
Neff
John M
JM
D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019988:Children with Disabilities; D004358:Drug Therapy; D005260:Female; D006701:Home Nursing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009330:Nebulizers and Vaporizers; D010030:Ostomy; D010351:Patient Discharge; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt