Characteristics and Utilization of Hospitalizations Among Children With Medical Complexity

Hospitalizations for children with medical complexity (CMC) have increased substantially over the past 2 decades and constitute a disproportionate percentage of hospitalization rates and costs among children. We sought to describe the etiology and utilization for hospitalizations of CMC using the Pediatric Clinical Classification System (PECCS).

Using the 2019 Kids' Inpatient Database, we classified hospitalizations for CMC using the PECCS, which groups diagnoses into mutually exclusive, pediatric-specific categories. For the medical, surgical, and medical/surgical PECCS clinical groups, we reported diagnosis groups accounting for ≥1% of hospital encounters for that group. We described admission frequency, cost, payer, length of stay, and mortality rates within each diagnosis grouping using survey-weighted statistics.

We identified 2 315 743 nonlivebirth hospitalizations, of which 712 139 (30.8%) were for CMC. Most (94.4%) hospitalizations occurred at a teaching hospital. Medical diagnosis comprised most hospitalizations (69.2%), whereas hospitalizations for surgical and medical/surgical conditions had a higher median cost. The most common diagnosis groups overall were encounters for chemotherapy, diabetic ketoacidosis, and respiratory failure, whereas the costliest were for necrotizing enterocolitis, transposition of the great vessels, and hypoplastic left heart syndrome.

We evaluated the most common diagnoses and their associated resource use for hospitalized CMC using the PECCS, providing a more granular view on the etiology, utilization, cost, and outcomes of hospitalizations for CMC. These topics represent high-impact areas for further research and quality efforts for CMC.