Development of a Medical Complexity Score for Pediatric Aerodigestive Patients

Area of Science:

• Pediatric Medicine
• Medical Complexity Assessment
• Aerodigestive Disorders

Background:

• Pediatric aerodigestive clinics manage a diverse patient population with complex medical needs.
• Characterizing patient complexity is crucial for predicting treatment outcomes and optimizing care.
• Existing scoring systems may not fully capture the spectrum of comorbidities in this population.

Purpose of the Study:

• To develop and validate a novel 7-point medical complexity scoring system for pediatric aerodigestive patients.
• To assess the score's ability to predict feeding progression in children with dysphagia.
• To stratify patient complexity for improved counseling and resource allocation.

Main Methods:

• A 7-point medical complexity score was developed using expert consensus, assigning points for specific comorbidities (airway, neurologic, cardiac, respiratory, gastrointestinal, genetic, prematurity).
• A retrospective chart review of 234 pediatric aerodigestive patients with at least two visits between 2017-2021 was performed.
• Univariate and multivariable logistic regression analyzed the score's predictive value for feeding progression in children with dysphagia.

Main Results:

• The complexity score (range 1-7) showed a normal distribution (median 4, mean 3.50 ± 1.47).
• Higher complexity scores were significantly associated with decreased success in oral feeding improvement among children with dysphagia (OR 0.66, P=0.001).
• Tube-fed children with higher scores were less likely to achieve a full oral diet (OR 0.60, P=0.01), with neurologic comorbidity and airway malformation being key predictors.

Conclusions:

• A novel, user-friendly medical complexity score effectively stratifies pediatric aerodigestive patients.
• The score demonstrates predictive value for feeding progression, particularly in children with dysphagia.
• This tool can aid clinicians in patient counseling and optimizing resource utilization for complex pediatric aerodigestive cases.