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. 2025 Mar 1;26(3):e304-e314.
doi: 10.1097/PCC.0000000000003668. Epub 2024 Dec 18.

Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020

Jessica A Schults  1   2   3 , Lisa Hall  4 , Karina R Charles  1   2   3   5 , Claire M Rickard  2   3 , Renate Le Marsney  3 , Endrias Ergetu  3 , Alex Gregg  6 , Joshua Byrnes  7 , Sarfaraz Rahiman  5 , Debbie Long  3   5   8 , Anna Lake  3 , Kristen Gibbons  3
Affiliations

Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020

Jessica A Schults et al. Pediatr Crit Care Med. .

Abstract

Objectives: To identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission.

Design: Propensity score matched cohort study analyzing routinely collected medical and costing data collected by the health service over 6 years (2015-2020).

Setting: Tertiary referral PICU in Queensland, Australia.

Patients: All children admitted to the PICU were included.

Interventions: None.

Measurements and main results: We assessed ventilator- and respiratory support-free days at 30 days post-PICU admission, length of PICU stay, prevalence of individual HACs, and attributable healthcare costs. A total of 8437 admissions, representing 6054 unique patients were included in the analysis. Median (interquartile range) for cohort age was 2.1 years (0.4-7.7 yr), 56% were male. Healthcare-associated infections contributed the largest proportion of HACs (incidence rate per 100 bed days, 46.5; 95% CI, 29.5-47.9). In the propensity score matched analyses (total 3852; 1306 HAC and 1371 no HAC), HAC events were associated with reduced ventilator- (adjusted subhazard ratio [aSHR], 0.88 [95% CI, 0.82-0.94]) and respiratory support-free days (aSHR, 0.74 [95% CI, 0.69-0.79]) and increased PICU length of stay (aSHR, 0.63 [95% CI, 0.58-0.68]). Healthcare costs for children who developed a HAC were higher compared with children with no HAC, with mean additional cost ranging from Australian dollar (A$) 77,825 (one HAC [95% CI, $57,501-98,150]) to $310,877 (≥ 4 HACs [95% CI, $214,572-407,181]; in 2022, the average conversion of A$ to U.S. dollar was 0.74).

Conclusions: In our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.

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Conflict of interest statement

Drs. Schultz’s and Le Marsney’s institution received funding from the Nursing and Midwifery Research Fellowship and the Children’s Hospital Foundation Mary McConnell grant. Dr. Rickard’s institution received funding from 3M/Solventum, BD, Cardinal Health, BBraun, ITL Biomedical, ICU Medical, Spectrum Vascular, and Angiodynamics. Dr. Le Marsney received support for article research from the Nursing and Midwifery Research Fellowship and the Children’s Hospital Foundation Mary McConnell grant (WIS142020). Dr. Lake received funding from Children’s Health QLD. Dr. Gibbons’ institution received funding from the Children’s Hospital Foundation and Queensland Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. Duke G, Shann F, Knott C, et al.: Hospital-acquired complications in critically ill patients. Criti Care Resus. 2021; 23:285–291
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