280 - Prevalence and Type of Technology Dependence in Hospitalized Children

Poster Number: 280
Publication Number: 280.80

Background: Hospitals and medical professionals need to be prepared to care for children with technology dependence (TD). Children with TD use some form of medical technology device that if it were to fail or be discontinued, they would likely suffer sufficiently adverse health consequences requiring hospitalization (Feudner 2005). Prior research on the prevalence of pediatric hospitalizations with TD has been limited to single hospitals and has not examined which types and combinations of TD are most common.

Objective: To determine: 1) the frequency of pediatric inpatient discharges with TD and 2) the most frequent types and combinations of TD.

Design/Methods: We performed a retrospective cross-sectional study of the 2019 Kids’ Inpatient Database (KID), the largest pediatric all-payer inpatient sample database. The KID includes all acute care hospital types (e.g., freestanding children’s hospitals, teaching hospitals, community hospitals) and is weighted to make national estimates. We excluded admissions for uncomplicated newborns and obstetrics/gynecology-related conditions. Using Feudtner’s 2014 pediatric Complex Chronic Conditions (CCC) classification system, we categorized 705 ICD-10 codes for TD into 51 distinct TD types. We used weights to determine frequencies and percentages of pediatric inpatient discharges with TD. We described the 10 most common types of TD and the five most common combinations of TD. We compared discharges with and without TD using chi square tests.

Results: Of the 3.5 million weighted discharges included, 25.2% had ≥1 CCC (Table 1). Among all discharges, 6.7% (95% CI: 6.1%-7.2%) had ≥1 TD. A higher percentage of discharges with TD had ≥1 CCC (94.0% vs. 20.3%, p< 0.001) and relied on Medicaid (55.2% vs. 49.3%, p< 0.001). The most common types of technology dependence were gastrostomy tubes (3.2% of all discharges) followed by ventricular shunts (0.9%), tracheostomies (0.8%), and supplemental oxygen (0.5%) (Table 2). Among discharges with TD, nearly 1/3 (29.4%) had ≥2 TDs. The most common combinations of TDs were gastrostomy tubes with either a tracheostomy (18.4% of combinations), supplemental oxygen (13.0%), or a ventricular shunt (12.7%) (Table 3).

Conclusion(s): Approximately 1 in 20 pediatric inpatient discharges had TD, with gastrostomy tubes being the most common type of TD. Among discharges with TD, combinations of ≥1 TD are common. Understanding the most common types of TD is important for improving preparedness of clinical teams including resource allocation and training.