Comorbid illnesses among critically ill hospitalized children: Impact on hospital resource use and mortality, 1997-2006

Objectives: To describe and compare hospital resource use and in-hospital mortality among critically ill hospitalized children according to comorbid illness status. Design: Secondary analysis of administrative data with generation of national estimates. Setting: None. Patients: Hospitalized children 0 to 18 yrs old with receipt of critical care services between 1997 and 2006. Interventions: None. Measurements and main results: There were 24,954 and 45,521 child hospitalizations with receipt of critical care services nationally in 1997 and 2006, respectively. In 1997, 35% of these hospitalizations had comorbid illnesses and 65% of these were in teaching hospitals. In 2006, 41% of critical care hospitalizations had comorbid illnesses, and 82% were in teaching hospitals. Cardiovascular diseases were the most common comorbid illnesses in 1997 (18%) and 2006 (22%). Mortality was significantly higher among patients with comorbid illness versus those without in 1997 (12.5% vs. 8.6%; p < .01) and in 2006 (10.8% vs. 7.8%; p < .01). Critically ill patients with comorbid illness vs. those without had significantly longer hospital stay in 1997 (30 days vs. 15 days; p < .01) and in 2006 (26 days vs. 14 days; p < .01). Corresponding charges were also significantly higher in the presence of comorbid illnesses vs. without, in 1997 ($131,203 vs. $62,070; p < .01) and in 2006 ($141,586 vs. $70,532; p < .01), expressed in 2006 U.S dollars. Across the 10-yr study period, hospital mortality was higher and hospital resource use greater among children with comorbid illness than children without. Conclusions: Among pediatric hospitalizations requiring use of critical care services, comorbid illness was associated with significantly higher in-hospital mortality and significantly greater hospital resource use pattern predominantly occurring in teaching hospitals. Policymaking regarding child critical care service delivery should anticipate exacerbation of these trends in the future, which have implications for bed availability and the overall acuity level in critical care settings.