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. 2011 Jul;128(1):5-13.
doi: 10.1542/peds.2010-2037. Epub 2011 Jun 27.

Adults with chronic health conditions originating in childhood: inpatient experience in children's hospitals

Denise M Goodman  1 , Matthew Hall, Amanda Levin, R Scott Watson, Roberta G Williams, Samir S Shah, Anthony D Slonim
Affiliations

Adults with chronic health conditions originating in childhood: inpatient experience in children's hospitals

Denise M Goodman et al. Pediatrics. 2011 Jul.

Abstract

Objective: To describe the rate of increase of the population of adults seeking care as inpatients in children's hospitals over time.

Patients and methods: We analyzed data from January 1, 1999, to December 31, 2008, from patients hospitalized at 30 academic children's hospitals, including growth rates according to age group (pediatric: aged <18 years; transitional: aged 18-21 years; or adult: aged >21 years) and disease.

Results: There were 3 343 194 hospital discharges for 2 143 696 patients. Transitional patients represented 2.0%, and adults represented 0.8%, totaling 59 974 patients older than 18 years. The number of unique patients, admissions, patient-days, and charges increased in all age groups over the study period and are projected to continue to increase. Resource use was disproportionately higher in the older ages. The growth of transitional patients exceeded that of others, with 6.9% average annual increase in discharges, 7.6% in patient-days, and 15% in charges. Chronic conditions occurred in 87% of adults compared with 48% of pediatric patients. Compared with pediatric patients, the rates of increase of inpatient-days increased significantly for transitional age patients with cystic fibrosis, malignant neoplasms, and epilepsy, and for adults with cerebral palsy. Annual growth rates of charges increased for transitional and adult patients for all diagnoses except cystic fibrosis and sickle cell disease.

Conclusions: The population of adults with diseases originating in childhood who are hospitalized at children's hospitals is increasing, with varying disease-specific changes over time. Our findings underscore the need for proactive identification of strategies to care for adult survivors of pediatric diseases.

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Figures

FIGURE 1
FIGURE 1
Increase in adults treated at children's hospitals, 1999–2012, according to age group. Shown are the aggregated actual 10-year and forecasted 3-year percentage growth from 1999 in discharges, charges, and patient-days of patients hospitalized at children's hospitals, according to age group. In aggregate, patients in the transitional age group had dramatic increase in discharges, charges, and patient-days. CI indicates confidence interval.
FIGURE 2
FIGURE 2
Increase in adults treated at children's hospitals, 1999–2012, according to age group and disease. The aggregated actual 10-year and forecasted 3-year percentage growth from 1999 in discharges, charges, and patient-days of patients hospitalized at children's hospitals, according to age group and disease: A, CF; B, malignant neoplasms; C, CHD; D, sickle cell disease; E, cerebral palsy; and F, epilepsy. CI indicates confidence interval.
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