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Complex Chronic Conditions in the PICU: Single-Center Retrospective Study in Central-Southern China, 2020-2025
Xun Li1,2,3, Haipeng Yan2,3,4, Xiao Li2,3
1Pediatrics Research Institute of Hunan Province, Affiliated Children's Hospital of Xiangya School of Medicine, Central South University (Hunan Children's Hospital), Changsha, China.
Complex chronic conditions (CCCs) in pediatric intensive care units (PICUs) significantly increase adverse outcomes. Specific CCC types and combinations, like metabolic and malignancy, pose higher risks, necessitating stratified management.
Area of Science:
- Pediatric critical care medicine
- Complex chronic conditions (CCCs) epidemiology
- Healthcare quality improvement
Background:
- Complex chronic conditions (CCCs) are increasingly common in pediatric intensive care units (PICUs).
- Effective risk stratification and targeted management for these patients are crucial.
- Understanding CCC patterns is essential for improving patient outcomes.
Purpose of the Study:
- To describe the distribution and patterns of CCCs in a tertiary PICU in China.
- To identify specific CCC types and combinations associated with adverse outcomes.
- To inform risk stratification and management strategies for children with CCCs.
Main Methods:
- Retrospective cohort study conducted between January 2020 and February 2025.
- Inclusion of pediatric patients (older than 28 days to 18 years) admitted to a single tertiary PICU.
- Analysis of 9589 PICU admissions using the Pediatric Complex Chronic Conditions Classification System Version 2.
Main Results:
- Nearly half (49%) of PICU admissions involved one or more CCCs.
- CCC admissions accounted for a disproportionate share of adverse outcomes, including 69.8% of adverse events and 70.8% of in-hospital deaths.
- Transplantation and metabolic CCCs, as well as combinations like metabolic and malignancy CCCs, were associated with significantly higher odds of adverse outcomes.
Conclusions:
- Patients with CCCs represent a significant burden on PICU resources and outcomes.
- The risk of adverse outcomes varies substantially based on the type and combination of CCCs.
- Implementing a stratified management approach for CCC patients is recommended to enhance care delivery and planning.
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