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Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study
Chris Feudtner1, Nanci Larter Villareale, Barbara Morray
1Pediatric Advanced Care Team, Integrated Care Service, and Pediatric Generalist Research Group, The Children's Hospital of Philadelphia, Philadelphia, USA. feudtner@email.chop.edu
Insights
Technology-dependency is common in children discharged from hospitals. Many rely on medical devices or multiple medications, highlighting the need for advanced care planning.
Area of Science:
- Pediatric Healthcare
- Medical Technology Impact
- Child Health Outcomes
Background:
- Medical technology advances may increase technology-dependent (TD) children.
- Assessing TD prevalence and support needs in pediatric populations is crucial.
Purpose of the Study:
- To determine the proportion of children discharged from a children's hospital who are technology-dependent (TD).
- To identify common devices and prescription medication counts for TD children at discharge.
Main Methods:
- A chart review of 100 randomly selected pediatric patients discharged in 2000.
- Four independent investigators classified patients as TD if technology failure had severe health consequences.
- Agreement among 3 or 4 raters was required for TD classification.
Main Results:
- 41% of discharged children were technology-dependent (TD).
- 20% required devices (e.g., gastrostomy tubes, central venous catheters, tracheotomies), 32% required medications, and 11% required both.
- TD children used a median of 2 prescription medications, with 12% using 5 or more.
Conclusions:
- Technology-dependency is a significant and common issue for children discharged from pediatric hospitals.
- Findings underscore the increasing need for specialized care and support for technology-dependent children post-discharge.
Background:
Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.
Methods:
Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.
Results:
Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0-13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.
Conclusion:
Technology-dependency is common among children discharged from a children's hospital.
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