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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.
Insights
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.
Objectives:
Complex chronic conditions (CCCs) are increasingly prevalent in the PICU. Identifying high-risk patterns of CCC and comorbidities is essential for patient risk stratification and targeted management. In this study, we aimed to describe the distribution and patterns of CCCs among children admitted to our tertiary PICU in China and to identify the types and combinations of conditions associated with a higher risk of adverse outcomes.
Design:
Retrospective cohort study, January 2020 to February 2025.
Setting:
Single center, at a tertiary referral PICU in Central-Southern China.
Patients:
Children older than 28 days, up to 18 years old.
Interventions:
None.
Measurements And Main Results:
CCCs were defined according to the Pediatric Complex Chronic Conditions Classification System Version 2. Of 9589 PICU admissions, 49% had one or more CCCs. Admissions with CCCs accounted for 69.8% of the adverse outcomes, 70.8% of in-hospital deaths, 58% of multiple organ dysfunction cases, and 57.6% of total patient days. Admissions with multiple CCC diagnoses were associated with higher odds of adverse outcomes compared with admissions with a single CCC diagnosis ( p < 0.0001). Transplantation and metabolic CCCs were associated with greater odds of adverse outcomes (odds ratios [OR], 6.06 and 5.27, respectively; p < 0.05). The most common co-occurring CCC categories were malignancy and hematologic/immunologic disorders. Among the most frequent combinations, the co-occurrence of metabolic and malignancy CCC was associated with greater odds of adverse outcomes (OR, 8.54 [95% CI, 4.48-16.29]). Admission with CCC was associated with pneumonia and sepsis ( p < 0.05).
Conclusions:
In our 2020-2025 experience, admission of patients with CCCs accounted for most of the adverse PICU outcomes. The odds of adverse outcomes varied across CCC types and combinations. Hence, incorporating CCCs into a stratified management approach across our healthcare system may support more effective planning and delivery of care.
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