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Children who 'grow up' in hospital: Inpatient stays of six months or longer
Dawn Davies1, Dawn Hartfield2, Tara Wren3
1John Dossetor Health Ethics Centre, University of Alberta; ; Department of Pediatrics, University of Alberta;
Insights
Critically ill children requiring prolonged hospitalization face high mortality and significant risks of family displacement. Special attention is needed for vulnerable Aboriginal children needing long-term care solutions.
Area of Science:
- Pediatric critical care medicine
- Hospital epidemiology
- Child health outcomes
Background:
- Prolonged hospitalizations in children are infrequent but resource-intensive.
- Understanding the clinical trajectory of these children is crucial for healthcare planning.
Purpose of the Study:
- To characterize the clinical course of pediatric patients with extended hospital stays (≥180 days).
- To identify common medical interventions and outcomes for children with prolonged hospitalizations.
Main Methods:
- Retrospective medical record review at a tertiary/quaternary children's hospital.
- Analysis of data from January 2007 to December 2012.
Main Results:
- 61 patients had 64 hospitalizations averaging 326 days.
- Tracheostomy/ventilation (52%), organ transplant (39%), and ventricular-assist devices (VADs) (11%) were common.
- Mortality was 26%, with 26% requiring long-term or out-of-home care; 88% of displaced children were Aboriginal.
Conclusions:
- Very long hospitalizations indicate complex pediatric illnesses with high mortality risks.
- Significant family displacement occurs post-discharge, with particular vulnerability among Aboriginal children.
- Multistakeholder collaboration is essential to address the needs of displaced children.
Objective:
To describe the clinical course of all infants and children hospitalized for six consecutive months (180 days) or longer at a tertiary/quaternary children's hospital in Western Canada.
Methods:
A retrospective review of medical records for all eligible patients from January 1, 2007 to December 31, 2012 at Stollery Children's Hospital (Edmonton, Alberta) was performed.
Results:
A total of 61 patients experienced 64 eligible hospitalizations. The mean length of stay was 326 days, corresponding to a cumulative 20,892 hospital days (57.2 patient-years). Prevalent procedures resulting in long hospitalization were long-term tracheostomy ± ventilation in 32 (52%) patients, need for organ transplantation in 24 (39%) with completed transplantation in 15 (25%), and ventricular-assist devices (VADs) in seven (11%). Sixteen (26%) patients in the study group died, and 16 (26%) were placed in long-term care or out-of-home care at the end of their long hospitalization. Of children displaced from their family home, 14 (88%) were Aboriginal.
Conclusion:
Infants and children who experience very long hospitalizations have complex illnesses, with substantial risk for mortality and a high rate of displacement from their families after discharge. Aboriginal children appear to be particularly vulnerable to displacement and problem solving for this population must be undertaken, involving a variety of stakeholders.
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