title: Pediatric Critical Care Resource Use by Children with Medical Complexity.
abstract: To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care children's hospitals.
  
  
  
  This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized.
  
  
  
  Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies.
  
  
  
  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.
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA.
authors.forename: Titus
authors.initials: T
authors.lastname: Chan
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rodean
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA.
authors.forename: Reid W D
authors.initials: RWD
authors.lastname: Farris
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Di Gennaro
authors.affiliation: Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Seattle Children's Research Institute, Seattle, WA.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D012189:Retrospective Studies
keywords: PICU; chronic diseases; comorbidities; critical care