TOP 70 - Characterizing Short Stay Critical Care Admissions for Children with Medical Complexity

Publication Number: 2824.TOP 70

Abbey Dallas, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Heather Wolfe, Perelman School of Medicine at the University of Pennsylvania, Coatesville, PA, United States; Emily F. Gregory, Children's Hospital of Philadelphia, PHILADELPHIA, PA, United States; Joseph J. Zorc, PRIME, Wynnewood, PA, United States

Background: Children with medical complexity (CMC) are a growing population defined, in part, by high healthcare utilization. Inpatient care accounts for the majority of healthcare costs for CMC and can negatively impact quality of life for patients and families. CMC represent 1.5% of the pediatric population, but 53% of admissions to the pediatric intensive care unit (PICU). Preliminary data in our hospital system indicate that 25% of CMC PICU admissions last two or fewer days. As short stay admissions may be a marker of potentially avoidable hospitalizations, we will characterize types of interventions received during short stay hospitalizations. Those with fewer interventions requiring an inpatient setting will be categorized as low resource use and may be identified as potentially avoidable hospitalizations. This is an initial step in an initiative to identify and prevent potentially avoidable short stay PICU admissions for CMC.

Objective: With this project, we aim to:
(1) Characterize short stay PICU hospitalizations for CMC using demographic information, type of medical complexity, primary encounter diagnoses, factors related to emergency department (ED) presentation, and inpatient interventions received.
(2) Describe variation in inpatient resource utilization among short stay PICU admissions for CMC.
(3) Inform future work to identify potentially avoidable short stay admissions for CMC.

Design/Methods: This retrospective chart review utilizes electronic health record data from September 1, 2024 through August 31, 2025, representing approximately 1,400 CMC PICU admissions. We applied a standard validated classification system to identify CMC using International Classification of Disease codes from problem lists. Short stay admissions are defined as two or fewer overnight periods. We will use descriptive analysis to characterize encounter-level demographic information, type of medical complexity, primary encounter diagnoses, factors related to ED presentation (e.g., ESI level, time of presentation), and types of inpatient interventions (e.g., procedures, respiratory support, workup, treatment) for CMC with short stay PICU admissions. We will use logistic regression to analyze differences in presenting factors for short stay PICU admissions for CMC with low resource use as compared to those with higher resource use. This study was reviewed by the IRB and determined to be exempt. Data collection is complete, and we aim to complete analysis by January 15, 2026.