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Predictors of emergency department utilisation in children with complex chronic conditions: a retrospective
Bibiana Pérez-Ardanaz1,2, Laura Gutiérrez-Rodríguez3,2, Celia Martí-García3
1Nursing Lecturer and Researcher, Department of Nursing, Faculty of Health Sciences, University of Granada, Spain.
Insights
Children with complex chronic conditions (CCCs) frequently use emergency departments (EDs). Non-malignant conditions, rehabilitation, and hospitalizations were linked to higher ED revisits, informing care coordination strategies.
Area of Science:
- Pediatric Healthcare
- Chronic Condition Management
- Healthcare Utilization
Background:
- Children with complex chronic conditions (CCCs) exhibit high emergency department (ED) utilization.
- This pattern strains acute care services and complicates care coordination efforts.
Purpose of the Study:
- Identify clinical and family factors predicting increased ED use in children with CCCs.
- Characterize the patterns of frequent service use (FSU) among this population.
Main Methods:
- Retrospective longitudinal cohort study (2015-2021) at a Spanish tertiary hospital.
- Included 248 children under 18 with CCCs (Feudtner v2 classification).
- Recurrent ED visits modeled using Cox Andersen-Gill; FSU defined as ≥8 ED visits.
Main Results:
- 96.8% of children utilized ED services, averaging 13.0 visits.
- Factors associated with higher ED revisit hazards included non-malignant CCCs, rehabilitation enrollment, increased hospitalizations (urgent/scheduled), and pediatric intensive care unit (PICU) admission.
- The predictive model achieved a C-index of approximately 0.71.
Conclusions:
- Routinely collected clinical data can aid in risk stratification for children with CCCs.
- Findings enhance nursing understanding of continuity and family-centered care for complex conditions.
- Further multicenter validation and prospective studies are recommended for developing targeted service models.
Background:
Children with complex chronic conditions (CCCs) frequently revisit emergency departments (EDs), increasing demand on acute services and challenging care coordination.
Aims:
To identify clinical and family factors associated with higher ED utilisation in children with CCCs and to characterise frequent service use (FSU).
Methods:
Retrospective longitudinal cohort at a tertiary hospital in Spain (2015-2021). We included 248 children <18 years with CCCs (Feudtner v2), regardless of ED use. Recurrent ED visits were modelled using a Cox Andersen-Gill approach from discharge of the index ED visit. Global FSU was described as ⩾8 ED visits during 2015-2021.
Results:
Overall, 240/248 (96.8%) children attended the ED (mean 13.0 visits; median 8, IQR 4-18). Higher hazards of ED revisits were associated with non-malignant CCC macro-groups, rehabilitation enrolment, higher urgent and scheduled hospitalisation counts and any PICU admission (C-index ≈ 0.71).
Conclusion:
Routinely recorded factors may support risk stratification and coordinated follow-up for children with CCCs. Contribution to nursing: This study strengthens nursing knowledge on continuity and family-centred complex care by identifying clinically relevant risk profiles in a tertiary-care cohort. Multicentre validation and prospective evaluation are needed before specific service models can be recommended.
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