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Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency
Sriram Ramgopal1, Julia A Heneghan2
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois USA.
Insights
Two common criteria for medical complexity in children, Complex Chronic Conditions (CCC) and Pediatric Medical Complexity Algorithm (PMCA), showed moderate agreement. These definitions identified different patient groups, highlighting the need for careful selection in research.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Chronic Disease Management
Background:
- The number of children with medical complexity in emergency departments (EDs) is increasing.
- Accurate identification of medical complexity is crucial for resource allocation and care coordination.
Purpose of the Study:
- To assess the concordance between two common definitions of medical complexity in children presenting to EDs.
- To compare the overlap and clinical outcomes associated with these two criteria.
Main Methods:
- Retrospective cross-sectional study of pediatric ED encounters in Illinois from 2016-2021.
- Classification of medical complexity using "Complex Chronic Conditions" (CCC) criteria and the "Pediatric Medical Complexity Algorithm" (PMCA).
- Comparison of patient populations and clinical outcomes (hospitalization, ICU admission, mortality) between the two criteria.
Main Results:
- Out of over 6.5 million pediatric ED encounters, 3.3% met CCC criteria and 2.7% met PMCA criteria.
- Moderate agreement (κ=0.49) was observed, with 34.1% of complex patients meeting both criteria.
- While overall outcomes were similar, the specific diagnoses and patient populations identified by CCC and PMCA differed.
Conclusions:
- The Complex Chronic Conditions (CCC) and Pediatric Medical Complexity Algorithm (PMCA) criteria identify distinct pediatric populations with medical complexity.
- Moderate agreement between the criteria necessitates careful consideration of operational definitions in clinical and health services research.
- Understanding these differences is vital for accurate research and effective healthcare delivery for complex pediatric patients.
Objective:
The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs.
Methods:
We conducted a retrospective cross-sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes.
Results:
Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in-hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non-specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%).
Conclusions And Relevance:
The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.
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