Increasing prevalence of medically complex children in US hospitals.
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.


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.
Burns
Katherine H
KH
Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-41, Little Rock, AR 72202, USA. burnskatherinel@uams.edu
Casey
Patrick H
PH
Lyle
Robert E
RE
Bird
T Mac
TM
Fussell
Jill J
JJ
Robbins
James M
JM
D001997:Bronchopulmonary Dysplasia / Q000628:therapy; D002547:Cerebral Palsy / Q000628:therapy; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy*; D019988:Children with Disabilities; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D014481:United States