Characteristics of US Nonchildren's Hospitals That Lost Pediatric Inpatient Capability, 2013-2021

Most US children receive care at nonchildren's hospitals. Trends over the past 2 decades have revealed decreasing pediatric inpatient capabilities. This study aimed to describe the hospital characteristics associated with loss of pediatric inpatient capabilities among a national sample of US nonchildren's hospitals between 2013 and 2021.

A secondary analysis was conducted using National Pediatric Readiness Project Assessments from 2013 to 2021. Hospitals with 1 or more reported pediatric inpatient unit capability (pediatric ward, pediatric intensive care unit [PICU], nursery/neonatal intensive care unit [NICU]) in 2013 and assessment responses in 2013 and 2021 were included. Multivariable logistic regression models were used to assess associations between hospital characteristics and loss of pediatric inpatient capabilities.

Of the 1570 included hospitals, 33.4% were urban high volume, 42.8% were nontrauma designated, and 40.9% had loss of 1 or more pediatric inpatient capability between 2013 and 2021. Multivariable analysis showed nonmetro status was associated with increased adjusted odds of pediatric ward loss (adjusted OR [aOR] 3.45; 95% CI, 2.42-4.94) and nursery/NICU loss (aOR, 2.93; 95% CI, 1.76-5.00) compared with urban high-volume hospitals. Trauma-designated hospitals had decreased adjusted odds of pediatric ward loss (aOR, 0.63; 95% CI, 0.47-0.83) and nursery/NICU loss (aOR, 0.60; 95% CI, 0.40-0.88).

Two in 5 hospitals with pediatric inpatient capability lost 1 or more capability between 2013 and 2021. Nonmetro hospitals had higher odds of capability loss, whereas trauma-designated hospitals had lower odds, highlighting geographic and structural disparities in pediatric inpatient service sustainability. Identifying impacts of these changes is critical to ensuring equitable access.