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Published on: August 25, 2014
[Children with special health care needs: prevalence in a pediatric hospital and associated risks]
Juan Carlos Flores1, Daniela Carrillo, Lorena Karzulovic
1Servicio de Salud Metropolitano Sur Oriente, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile. jcflorescano@gmail.com
Insights
Children with special health care needs (CSHCN) requiring care from three or more professionals face higher risks of adverse events during hospitalization. This highlights the need for targeted interventions for these vulnerable pediatric patients.
Area of Science:
- Pediatric Healthcare
- Public Health
- Epidemiology
Context:
- The definition of Children with Special Health Care Needs (CSHCN) was adopted in Chile in 2008.
- Increasing life expectancy in Chile contributes to a growing prevalence of CSHCN.
- This demographic shift is associated with escalating healthcare costs.
Purpose:
- To characterize the epidemiological and clinical profiles of hospitalized CSHCN.
- To evaluate the risk of adverse events in hospitalized CSHCN.
- To compare risk assessments using two distinct CSHCN definitions.
Summary:
- A cohort study in Santiago, Chile, analyzed 920 hospitalized children.
- The CSHCN-3 definition identified 19.9% of patients, showing increased risks for ICU admission, nosocomial infections, and prolonged hospitalization compared to non-CSHCN.
- The broader CSHCN definition did not reveal excess risk compared to non-CSHCN.
Impact:
- One in five hospitalized children met the CSHCN-3 criteria, indicating a significant population at risk.
- CSHCN-3 patients experienced a higher incidence of critical adverse events during hospitalization.
- Findings underscore the importance of the CSHCN-3 definition for identifying high-risk pediatric populations and informing targeted care strategies.
Background:
"Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs.
Aim:
To describe the epidemiological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN.
Patients And Methods:
A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (> 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN.
Results:
Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001).
Conclusions:
One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN.
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