Technology-dependency among patients discharged from a children's hospital: a retrospective cohort study
1 Pediatric Advanced Care Team, Integrated Care Service, and Pediatric Generalist Research Group, The Children's Hospital of Philadelphia; Philadelphia, USA
2 The Leonard Davis Institute and the Center for Bioethics, University of Pennsylvania, Philadelphia, USA
3 Center for Children with Special Needs, Children's Hospital & Regional Medical Center, Seattle, USA
4 Pediatric Palliative Care Program, Children's Hospital and Regional Medical Center, Seattle, USA
5 Department of Rehabilitation Medicine, University of Washington, Seattle, USA
6 Department of Pediatrics, University of Washington, Seattle, USA
BMC Pediatrics 2005, 5:8 doi:10.1186/1471-2431-5-8Published: 9 May 2005
Advances in medical technology may be increasing the population of children who are technology-dependent (TD). We assessed the proportion of children discharged from a children's hospital who are judged to be TD, and determined the most common devices and number of prescription medications at the time of discharge.
Chart review of 100 randomly selected patients from all services discharged from a children's hospital during the year 2000. Data were reviewed independently by 4 investigators who classified the cases as TD if the failure or withdrawal of the technology would likely have adverse health consequences sufficient to require hospitalization. Only those cases where 3 or 4 raters agreed were classified as TD.
Among the 100 randomly sampled patients, the median age was 7 years (range: 1 day to 24 years old), 52% were male, 86% primarily spoke English, and 54% were privately insured. The median length of stay was 3 days (range: 1 to 103 days). No diagnosis accounted for more than 5% of cases. 41% were deemed to be technology dependent, with 20% dependent upon devices, 32% dependent upon medications, and 11% dependent upon both devices and medications. Devices at the time of discharge included gastrostomy and jejeunostomy tubes (10%), central venous catheters (7%), and tracheotomies (1%). The median number of prescription medications was 2 (range: 0–13), with 12% of cases having 5 or more medications. Home care services were planned for 7% of cases.
Technology-dependency is common among children discharged from a children's hospital.