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Observational Study
. 2025 May 31;184(6):378.
doi: 10.1007/s00431-025-06227-0.

Impact of complex chronic diseases and life-limiting condition status on paediatric hospitalization: observational study

Idoya Serrano-Pejenaute  1   2 , Itziar Astigarraga  3   4 , Álvaro Sánchez Pérez  5
Affiliations
Observational Study

Impact of complex chronic diseases and life-limiting condition status on paediatric hospitalization: observational study

Idoya Serrano-Pejenaute et al. Eur J Pediatr. .

Abstract

Children with medical complexity (CMC) and life-limiting conditions (LLCs) have a high utilization of healthcare resources. This study aims to assess the impact of CMC and LLC on hospitalization in the Basque Public Health System (BPHS) and to compare CMC to LLC to characterize inpatient health utilization. This is a retrospective observational study including all admissions of paediatric patients (< 19 years) to the BPHS during the period 2018-2020. The Pediatric Medical Complexity Algorithm and the Hain Directory of Life-Limiting Conditions were used to identify children with complex chronic diseases (C-CDs) and LLCs, respectively. Inpatient health utilization and in-hospital mortality of patients with C-CD and LLC were compared to those without these conditions. A total of 34,555 admissions were recorded for 26,196 patients during the study period. Patients with C-CD and LLC accounted for 15.4% and 14.4% of these admissions, respectively. Patients with LLC were more likely to require respiratory or hemodynamic support and device placement than patients with C-CD. Children with LLC and C-CD exhibited a higher frequency and length of stay of both general and ICU admissions than those without these conditions. Eight out of ten patients who died during admission had C-CD and/or LLC, with a higher probability of in-hospital death among patients with LLC.

Conclusion: A considerable proportion of admissions among children was attributed to patients with C-CD and LLC. Both exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC. Further studies focused on cost/expenditures are needed within a publicly insured health system.

What is known: • Children with medical complexity (CMC) consume a lot of healthcare resources, and their in-hospital mortality is high. There are several ways to identify CMC in health datasets. Both children with chronic complex disease (C-CD) and life-limiting conditions (LLC) are CMC.

What is new: • There is an important overlap between children classified as having C-CD and those with LLC. Both groups exhibited substantial utilization of hospital resources and high in-hospital mortality, being more pronounced among patients with LLC.

Keywords: Chronic disease; Hospital mortality; Hospitalized children; Paediatrics; Palliative care.

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Conflict of interest statement

Declarations. Ethical approval: The Research Ethics Committee of the Basque Country approved the present study (CEI code 01/2022/PI2021216). We conducted this study according to international standards for epidemiological studies, as outlined in the International Guidelines for the Ethical Review of Epidemiological Studies and the Spanish Society of Epidemiology’s recommendations on ethical aspects of epidemiological research. Competing interest: The authors declare no competing interests.

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