title: Cross-sectional comparison of critically ill pediatric patients across hospitals with various levels of pediatric care.
abstract: BACKGROUND
  Inpatient administrative data sources describe the care provided to hospitalized children. The Kids' Inpatient Database (KID) provides nationally representative estimates, while the Pediatric Health Information System (PHIS, a consortium of pediatric facilities) derives more detailed information from revenue codes. The objective was to contextualize a diagnosis and procedure-based definition of critical illness to a revenue-based definition; then compare it across hospitals with different levels of pediatric care.
  
  
  METHODS
  This retrospective, cross-sectional study utilized the 2009 KID, and 2009 inpatient discharges from the PHIS database. Patients <21 years of age (excluding neonates) were included to focus on pediatric critical illness. Critical illness was defined as: (1) critical care services (CC services) using diagnosis and procedures codes and (2) intensive care unit (ICU) care using revenue codes. Demographics, invasive procedures, and categories of critical illness were compared using Chi square and survey-weighted methods. The definitions of critical illness were compared in PHIS hospitals. CC services populations identified in General Hospitals, Pediatric Facilities, and Freestanding Children's hospitals (from KID) were compared to those in PHIS hospitals.
  
  
  RESULTS
  Among PHIS hospitals, critically ill discharges identified by CC services accounted for 37.7% of ICU care. CC services discharges were younger and had greater proportion of respiratory illness and invasive procedure use. Critically ill patients identified by CC services in PHIS hospitals were statistically similar to those in Freestanding Children's hospitals. Pediatric Facilities and General Hospitals had more adolescents with more traumas. CC services patients in general hospitals had lower use of invasive procedures and predominance of trauma, respiratory illness, mental health issues, and general infections. Freestanding children's hospitals discharged 22% of the estimated 96,700 CC services cases. Similar proportions of critically ill patients were seen in Pediatric Facilities (31%) and General Hospitals (33%).
  
  
  CONCLUSIONS
  The CC services definition captured a more severely ill fraction of critically ill children. Critically ill discharges from PHIS hospitals can likely be extrapolated to Freestanding Children's hospitals and Pediatric Facilities. General Hospitals, which provide a significant amount of pediatric critical care, are different. Studies utilizing administrative data can benefit from multiple data sources, which balance the individual strengths and weaknesses.
authors.affiliation: Section of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dive, RI 2117, Indianapolis, IN, 46202, USA. bbenneyw@iu.edu.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Benneyworth
authors.affiliation: Section of Pediatric Gastroenterology, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Dive, RI 4210, Indianapolis, IN, 46202, USA. webjr@iupui.edu.|Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, 410 West 10th Street, HS Suite 4099C, Indianapolis, IN, 46202, USA. webjr@iupui.edu.
authors.forename: William E
authors.initials: WE
authors.lastname: Bennett
authors.affiliation: Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, 410 West 10th Street, HS Suite 4099C, Indianapolis, IN, 46202, USA. aaecarro@iu.edu.
authors.forename: Aaron E
authors.initials: AE
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult