Excess risk of severe acute illness in children with chronic health conditions

We estimated the relative risk (RR) of an unscheduled pediatric intensive c are unit (ICU) admission as a marker for severe acute illness in children w ith chronic health conditions, compared with previously healthy children. P otentially preventable events that lead to acute illness were identified to develop preventive strategies. Methods. Children with chronic conditions were defined as those who have a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that r equired by children generally. RR was estimated from admissions and regiona l population data. Potentially preventable events that lead to ICU admissio n of chronically ill children were identified retrospectively from hospital records. Results. Children with chronic health conditions had an RR of 3.3 for an un scheduled ICU admission related to their chronic condition, compared with p reviously healthy individuals (95% confidence interval [CI] = 2.5-4.2). The risk of severe acute illness in the small subgroup that received technolog y-assisted care was much greater (RR = 373; 95% CI = 330-422) than for the large group of chronically ill patients who did not require technology-assi sted care (RR = 2.3; 95% CI = 1.7-3.0), each expressed relative to previous ly healthy children. Acute illness related to chronic health conditions acc ounted for 45% of 251 unscheduled ICU admissions during the 1-year study. T hirty-two percent of admissions that were related to chronic conditions wer e judged to have been potentially preventable. Preventable events were more common for those who did not require technology-assisted care, occurring i n 38% of admissions, compared with those who received technology-assisted c are, for whom 19% of admissions involved a preventable event. Fifty-six per cent of potentially preventable events involved the physical or social envi ronment and decisions made by the family, whereas 64% could be attributed t o health care system factors. Conclusions. Children with chronic health conditions account for a substant ial share of severe acute illness in a region. Because their underlying con ditions have already been identified, problems may be anticipated. The smal l number of children who receive technology-assisted care each have such a high risk of severe and unavoidable acute illness that individualized emerg ency care plans are justified. For the remainder of children with chronic c onditions, investigation of health system strategies to improve families' a bility to anticipate, minimize, or prevent related acute illness is warrant ed.