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Predictive model for the risk of paediatric intensive care utilization in children with medical complexity: A

Bibiana Pérez-Ardanaz1,2, Laura Gutiérrez-Rodríguez2,3, Alberto José Gómez-González2,3

  • 1Department of Nursing, Faculty of Health Sciences, Universidad de Granada, Granada, Spain.

Nursing in Critical Care
|October 9, 2024
PubMed

Insights

Children with medical complexity (CMC) face higher intensive care risks. Maternal education and age are protective factors, suggesting socio-demographic considerations can prevent paediatric intensive care unit (PICU) admissions.

Area of Science:

  • Pediatric critical care medicine
  • Health services research
  • Social determinants of health

Background:

  • Children with medical complexity (CMC) have elevated risks of intensive care unit (ICU) admission.
  • Despite improved mortality, CMC experience significant morbidity, long-term healthcare needs, and hospital readmissions.
  • Socio-demographic factors, beyond clinical aspects, may influence acute service utilization in CMC.

Purpose of the Study:

  • To identify risk factors distinguishing CMC admitted to the paediatric intensive care unit (PICU).
  • To explore the impact of clinical, socio-demographic, and healthcare utilization variables on PICU admission risk.

Main Methods:

  • A 6-year longitudinal retrospective cohort study.
  • Evaluation of clinical data, socio-demographic information, and healthcare utilization patterns.
  • Statistical analysis including hazard ratios (HR) and multivariable analysis.

Main Results:

  • The study included 248 CMC, with a 47.2% PICU admission rate.
  • Surgical interventions (HR=1.58) and home medical devices (HR=1.81) increased PICU admission risk.
  • Higher maternal educational level (HR=0.66) was a protective factor; age and maternal education were protective in multivariable analysis.

Conclusions:

  • Socio-demographic factors, particularly maternal education, are crucial in managing CMC care.
  • Individualized assessments considering socio-economic determinants can potentially prevent PICU admissions.
  • Integrating socio-demographic risk assessments into clinical practice, especially for paediatric nurses, can optimize care and support interventions.
Abstract

Keywords:
childrenhealth resourcesmultiple chronic conditionsnursingpaediatric critical care

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