Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample
Abstract Objective The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods We conducted a re...
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12950 |
| _version_ | 1797795168776093696 |
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| author | Sriram Ramgopal Julia A. Heneghan |
| author_facet | Sriram Ramgopal Julia A. Heneghan |
| author_sort | Sriram Ramgopal |
| collection | DOAJ |
| description | Abstract Objective The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods We conducted a retrospective cross‐sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Results Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in‐hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non‐specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). Conclusions and Relevance The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research. |
| first_indexed | 2024-03-13T03:14:53Z |
| format | Article |
| id | doaj.art-4519cd20efcb4adebe3f289bb128d173 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-03-13T03:14:53Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-4519cd20efcb4adebe3f289bb128d1732023-06-26T04:54:29ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-06-0143n/an/a10.1002/emp2.12950Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sampleSriram Ramgopal0Julia A. Heneghan1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois USADivision of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital University of Minnesota Minneapolis Minnesota USAAbstract Objective The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods We conducted a retrospective cross‐sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Results Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in‐hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non‐specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). Conclusions and Relevance The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.https://doi.org/10.1002/emp2.12950children with medical complexitycomplex chronic conditionscomplex chronic diseaseemergency carepediatric medical complexity algorithm |
| spellingShingle | Sriram Ramgopal Julia A. Heneghan Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample Journal of the American College of Emergency Physicians Open children with medical complexity complex chronic conditions complex chronic disease emergency care pediatric medical complexity algorithm |
| title | Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| title_full | Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| title_fullStr | Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| title_full_unstemmed | Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| title_short | Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| title_sort | comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample |
| topic | children with medical complexity complex chronic conditions complex chronic disease emergency care pediatric medical complexity algorithm |
| url | https://doi.org/10.1002/emp2.12950 |
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