517 - Adults and Adolescents with High Intensity Neurologic Impairment Hospitalized at Children’s Hospitals

Publication Number: 1497.517

Charles I. Maloy, Children's Mercy Hospitals and Clinics, Lenexa, KS, United States; Joanna Thomson, Cincinnati Children's, Cincinnati, OH, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States; Hank Puls, Children's Mercy Kansas City, Kansas City, KS, United States

Background: Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood increases, children's hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population.

Objective: Compare characteristics of adults and adolescents with HINI hospitalized at children's hospitals and describe hospital-level variation in hospitalizations for adults with HINI.

Design/Methods: This was a retrospective cross-sectional study of hospitalizations for patients with HINI aged 12-29 years discharged from the 48 children's hospitals in the Pediatric Health Information System during 2022-24. Discharges were categorized by age: adolescents (12-17 years) and adults (18-29 years). Chi-square and Wilcoxon Rank-Sum tests compared the two groups by hospitalization level characteristics, intensive care use, hospital length of stay, in-hospital mortality, and mean cost of hospitalization. HINI combinations were quantified for each group and ordered by prevalence. Hospital-level variation was described using the percentage of included HINI discharges that were adults and correlated with hospital volume of included HINI discharges using Pearson's coefficient.

Results: There were 142,823 hospitalizations included, 23.9% were adults. Compared to adolescents, adults were more likely to have >1 HINI category (40.3% vs 33.9%), a co-morbid non-neurologic CCC (72.4% vs 58.7%), and technology use (48.5% vs 37.9%) (Table). Figure 1 shows the types and combinations of HINI conditions most commonly present among adolescent and adult hospitalizations. Epilepsy alone was more prevalent in adolescents while epilepsy+static was more common in adults. Adults had longer length of stay, less ICU use, similar mortality, and higher hospitalization costs (Table). There was substantial hospital-level variation in the percentage of included HINI hospitalizations that were adults (range 0.0% to 35.7%; Figure 2), which was not correlated with hospital volume of all HI-NI discharges aged 12-29 years (p=0.27).

Conclusion(s): Adults with HINI were generally more complex and incurred longer hospitalizations and greater inpatient costs than their adolescent counterparts. Hospital-level variation in adults with HINI hospitalized at children's hospitals was not explained by hospital volume of HINI discharges and may result from differences in the transition processes between institutions. Future studies should seek to understand optimal transition timing and care setting for these patients.

Table: Characteristics and Utilization Pattern of Adolescents (12-17 years) and Adults (18-29 years) with High Intensity Neurologic Impairment Hospitalized at one of 48 Children's Hospitals During 2022-2024
*SD = Standard Deviation

Figure 1: Most Frequent High Intensity Neurologic Impairment (HINI) Combinations
The ten most common combinations of HINI among adolescents (12-17) and young adults (18-29) discharged from a children's hospital.
These diagnoses include 82.8% of all included adolescents and 79.5% of all included adults.

FIgure 2: Variability in Discharges of Young Adults by Pediatric Hospital
Percentage of discharges that were adults (18-29 year olds) with High Intensity Neurologic Impairment among discharges of those 12-29 years old with High Intensity Neurologic Impairment
There was no association between the percentage of hospitalizations of HINI that were adults and the total volume of included HINI hospitalizations: p=0.274