Pérez-Ardanaz Bibiana, Gutiérrez-Rodríguez Laura, Gómez-González Alberto José, Morales-Asencio José Miguel, Montero-García Antonio, León-Campos Álvaro
Department of Nursing, Faculty of Health Sciences, Universidad de Granada, Granada, Spain.
Instituto de Investigación Biomédica de Málaga (IBIMA-Bionand), Málaga, Spain.
Nurs Crit Care. 2025 May;30(3):e13180. doi: 10.1111/nicc.13180. Epub 2024 Oct 8.
Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services.
To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU).
A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization.
A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors.
Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions.
This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care.
患有复杂疾病的儿童（CMC）入住重症监护病房的风险增加。尽管死亡率有所改善，但仍存在发病负担、长期医疗需求和医院再入院问题。除临床因素外，社会人口学决定因素可能会影响急性服务的利用情况。
确定能够区分入住儿科重症监护病房（PICU）的CMC的风险因素。
一项为期6年的纵向回顾性队列研究，评估了临床、社会人口学和医疗服务利用情况。
共纳入248名CMC，中位年龄为13岁（9.75 - 17.00）。重症监护病房入住率为47.2%。接受手术干预的儿童（HR = 1.58, 95% CI 1.34 - 1.86, p <.001）和使用医疗设备的儿童（HR = 1.81, 95% CI 1.54 - 2.13, p <.001）入住PICU的风险更高。母亲较高的教育水平是一个保护因素（HR = 0.66, 95% CI 0.55 - 0.79, p <.001）。多变量分析显示，入院风险与恶性肿瘤、合并症、家庭医疗设备、外科手术以及更高的医疗服务利用率之间存在显著关联。儿童年龄和母亲较高的教育水平起到了保护作用。
在为CMC提供护理时应考虑社会人口学因素。进行个体化评估以指导适应社会经济因素的支持性干预措施可能会预防PICU入院。
本研究强调了将社会人口学风险因素（如母亲教育水平）的个体化评估纳入儿科护士临床实践的重要性。此外，有针对性的干预措施，包括教育资源和社区支持项目，可能会优化护理。
