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Updating the Epidemiology of Pediatric Critical Care in the United States: 2001-2022
Elizabeth Y Killien1,2, Matthew R Keller3, Karen E Segar4
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington, Seattle, WA.
Insights
Pediatric intensive care unit (ICU) admissions for children increased significantly from 2001 to 2022, with rising ICU care prevalence. This highlights an urgent need to expand pediatric critical care capacity in the U.S.
Area of Science:
- Pediatric critical care medicine
- Healthcare utilization research
- Public health policy
Background:
- Pediatric hospital and intensive care unit (ICU) admission patterns have evolved.
- Understanding these trends is crucial for resource allocation and patient care.
- The COVID-19 pandemic's impact on pediatric critical care requires updated analysis.
Purpose of the Study:
- To analyze changes in pediatric hospital and ICU admission patterns from 2001 to 2022.
- To assess the regionalization of pediatric critical care over time.
- To evaluate the impact of the COVID-19 pandemic on pediatric critical care admissions and outcomes.
Main Methods:
- Retrospective cohort study utilizing Healthcare Cost and Utilization Project's State Inpatient Databases from 21 U.S. states (2001-2022).
- International Classification of Diseases (ICD-9/10-CM) codes identified diagnoses, comorbidities, organ failures, and mechanical ventilation.
- Generalized linear Poisson regression and Cuzick's test analyzed trends; U.S. Census data provided population-based rates.
Main Results:
- Hospital admissions decreased, while ICU admissions rose, increasing from 10.5% to 20.7% of hospitalizations between 2001 and 2022.
- Admission to highest-level pediatric facilities increased from 41.1% (2001) to 72.3% (2019), then slightly decreased to 69.3% (2022).
- ICU mortality decreased (2.4% to 1.6%), but comorbidities and technology dependence rose. National ICU admissions increased from 239,000 (2019) to 328,000 (2022), with costs rising from $11.6B to $14.4B.
Conclusions:
- U.S. pediatric ICU admissions and the prevalence of ICU care among hospitalized children significantly increased through 2022.
- Despite improved outcomes, the rising demand necessitates increased pediatric critical care capacity.
- Healthcare systems must adapt to meet the growing needs of critically ill children.
Objectives:
To update data from 2001 to 2019 to evaluate how hospital and ICU admission patterns for children changed after the onset of the COVID-19 pandemic and to characterize regionalization of pediatric critical care over time.
Design:
Retrospective cohort study.
Setting:
Healthcare Cost and Utilization Project's State Inpatient Databases from 21 U.S. states over 6 years between 2001 and 2022.
Patients:
Hospitalized children of 0-17 years, excluding newborns.
Interventions:
None.
Measurements And Main Results:
We used International Classification of Diseases, 9th revision (ICD-9)-clinical modification (CM) and International Classification of Diseases, 10th revision (ICD-10)-CM codes to identify diagnoses, comorbid conditions, organ failures, and mechanical ventilation, and used generalized linear Poisson regression and Cuzick's test to evaluate trends from 2001 to 2022. We used U.S. Census data to generate population-based incidence rates and age- and sex-adjusted national estimates of ICU admissions and costs. Of 2,617,308 hospital admissions, 410,646 admissions (15.7%) included a non-neonatal ICU admission. The population-based incidence of hospital admissions decreased from 2001 to 2022 while ICU admissions rose; ICU admission prevalence increased from 10.5% of hospitalizations in 2001 to 20.7% in 2022. The percentage of ICU patients admitted to the highest-level pediatric facilities rose from 41.1% in 2001 to 72.3% in 2019 before decreasing to 69.3% in 2022. Between 2019 and 2022, the percentage of ICU patients with chronic comorbidities, technology dependence, and organ failure decreased slightly, but the population-based incidence of comorbidities and technology dependence rose. ICU mortality decreased from 2.4% in 2001 to 1.6% in 2022. Nationally, there were an estimated 239,000 ICU admissions in 2019, increasing to 328,000 in 2022, with a rise in total hospital costs (in 2022 dollars) from $11.6 billion in 2019 to $14.4 billion in 2022.
Conclusions:
The number of U.S. children admitted to ICUs continued to increase substantially in 2022, with rising prevalence of ICU care among hospitalized children, emphasizing the need for the U.S. healthcare system to increase pediatric critical care capacity.
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