32: THE EPIDEMIOLOGY OF PEDIATRIC INTENSIVE CARE ADMISSIONS IN THE UNITED STATES: 2001-2019

Introduction: Understanding how pediatric ICU admission patterns are changing is necessary to anticipate future needs for hospitalized children. Methods: We conducted a population-based retrospective cohort study of children < 18 yrs old from the Healthcare Cost and Utilization Project’s State Inpatient Databases from 21 states in 2001, 2004, 2010, 2016, and 2019 who received care in a non-neonatal ICU. We extracted patient characteristics and used ICD-9-CM and ICD-10-CM codes to identify diagnoses, organ failures, and procedures. We used American Hospital Association data to identify hospital characteristics and US census data to generate age- and sex-adjusted national estimates. Results: Of 2,157,991 pediatric admissions, 11.7% (n=251,787) included ICU care. From 2001-2019, pediatric hospitalizations fell by 35.9% while ICU admissions increased, leading to a doubling of the rate of hospitalized children in an ICU (6.9% to 15.5%). From 2001-2019, the percent of ICU admissions in dedicated PICUs rose from 54.9% to 82.5%. The percent of children admitted to an ICU with a chronic comorbid condition rose 29.3% with a 46.9% increase in patients with baseline technology dependence. The percent of children admitted to an ICU for respiratory conditions increased by 66.8%, and multiple organ dysfunction syndrome (MODS) tripled to 20.9%. From 2001-2019, hospital length of stay (LOS) increased for ward (mean 4.3 d, SD +9.9 to 5.1 d, SD + 11.2) and ICU admissions (mean 7.7 d, SD +12.9 to 8.9 d, SD +19.4), with ICU admissions in children’s hospitals being 35% longer than those in community hospitals. LOS was longer for children who received mechanical ventilation (mean 17.1 d, SD +27.8) or had MODS (18.8 d, SD +29.9). From 2001-2019, in-hospital mortality for children in an ICU fell from 2.4% to 1.8%, and mortality for children with MODS fell from 18.8% to 7.6%. Median costs of ICU care nearly doubled from 2001-2019 from $8,638 (IQR $4,174-$19,929) to $15,807 (IQR $7,448-$40,135). Nationally, an estimated 239,000 children were admitted to a US ICU in 2019, corresponding to $11.6 billion in hospital costs. Conclusions: The number of US children receiving ICU care is rising, as is their medical complexity and associated technology use. The US healthcare system must be equipped to care for these children in the future.