Serrano-Pejenaute Idoya, Astigarraga Itziar, Sánchez Pérez Álvaro
Department of Pediatrics, Hospital of Zumarraga, Barrio Argixao, S/N, 20700, Zumarraga, Spain.
Biogipuzkoa Health Research Institute, Donostia, Gipuzkoa, Spain.
Eur J Pediatr. 2025 May 31;184(6):378. doi: 10.1007/s00431-025-06227-0.
Children with medical complexity (CMC) and life-limiting conditions (LLCs) have a high utilization of healthcare resources. This study aims to assess the impact of CMC and LLC on hospitalization in the Basque Public Health System (BPHS) and to compare CMC to LLC to characterize inpatient health utilization. This is a retrospective observational study including all admissions of paediatric patients (< 19 years) to the BPHS during the period 2018-2020. The Pediatric Medical Complexity Algorithm and the Hain Directory of Life-Limiting Conditions were used to identify children with complex chronic diseases (C-CDs) and LLCs, respectively. Inpatient health utilization and in-hospital mortality of patients with C-CD and LLC were compared to those without these conditions. A total of 34,555 admissions were recorded for 26,196 patients during the study period. Patients with C-CD and LLC accounted for 15.4% and 14.4% of these admissions, respectively. Patients with LLC were more likely to require respiratory or hemodynamic support and device placement than patients with C-CD. Children with LLC and C-CD exhibited a higher frequency and length of stay of both general and ICU admissions than those without these conditions. Eight out of ten patients who died during admission had C-CD and/or LLC, with a higher probability of in-hospital death among patients with LLC.
A considerable proportion of admissions among children was attributed to patients with C-CD and LLC. Both exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC. Further studies focused on cost/expenditures are needed within a publicly insured health system.
• Children with medical complexity (CMC) consume a lot of healthcare resources, and their in-hospital mortality is high. There are several ways to identify CMC in health datasets. Both children with chronic complex disease (C-CD) and life-limiting conditions (LLC) are CMC.
• There is an important overlap between children classified as having C-CD and those with LLC. Both groups exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC.
患有复杂病症（CMC）和危及生命病症（LLC）的儿童对医疗资源的利用率很高。本研究旨在评估CMC和LLC对巴斯克公共卫生系统（BPHS）住院情况的影响，并比较CMC和LLC以描述住院患者的医疗资源利用情况。这是一项回顾性观察研究，纳入了2018年至2020年期间BPHS收治的所有儿科患者（<19岁）。分别使用儿科复杂病症算法和《海恩危及生命病症名录》来识别患有复杂慢性病（C - CD）和LLC的儿童。将患有C - CD和LLC的患者的住院医疗资源利用情况和住院死亡率与未患这些病症的患者进行比较。研究期间共记录了26196名患者的34555次住院情况。患有C - CD和LLC的患者分别占这些住院病例的15.4%和14.4%。与患有C - CD的患者相比，患有LLC的患者更有可能需要呼吸或血流动力学支持以及设备植入。患有LLC和C - CD的儿童在普通病房和重症监护病房的住院频率和住院时间均高于未患这些病症的儿童。入院期间死亡的患者中有十分之八患有C - CD和/或LLC，LLC患者的住院死亡概率更高。
儿童住院病例中有相当一部分归因于患有C - CD和LLC的患者。两者都表现出对医院资源的大量利用和较高的住院死亡率，在患有LLC的患者中更为明显。在公共保险的卫生系统内，需要开展更多关注成本/支出的研究。
• 患有复杂病症（CMC）的儿童消耗大量医疗资源，且住院死亡率很高。在健康数据集中有多种识别CMC的方法。患有慢性复杂疾病（C - CD）和危及生命病症（LLC）的儿童均为CMC。
• 被归类为患有C - CD的儿童和患有LLC的儿童之间存在重要重叠。两组都表现出对医院资源的大量利用和较高的住院死亡率，在患有LLC的患者中更为明显。
