(348) Trends and Utilization in Adolescents and Young Adults Admitted to PICUs From 2013-2022

Introduction: Adolescents and young adults (AYAs) with complex chronic conditions (CCCs) are an expanding population in pediatric hospitals. Despite calls to transition from pediatric to adult medical homes, a growing proportion of pediatric emergency department visits and inpatient hospitalizations over the past decade are AYAs with CCCs. We sought to describe AYAs admitted to pediatric intensive care units (PICUs) with and without CCCs and compare them to younger pediatric peers. We hypothesized increased admissions of AYAs, especially those with CCCs.

Methods: Using the Pediatric Health Information Systems (PHIS) database, we performed a repeated cross-sectional series of patients with an ICU charge from 1/1/2013-12/31/2022. Patients ≥40 years old were excluded from analysis. Patient and utilization characteristics were assessed including age, sex, insurance status, ICU length of stay (LOS), as well as use of mechanical ventilation, parenteral nutrition, and ECMO. CCCs were identified using ICD coding systems. Encounters were stratified by calendar year and age (≥15 years vs. < 15).

Results: Of the 936,958 PICU encounters from 2013-2022, 154,785 (16.5%) were AYA patients, with a median age of 17.2 years (vs. 2.6 years for younger cohort). AYAs and younger children had similar rates of sex distribution (45% female), mean admissions per unique patient (1.42), mean ICU LOS (5.73 days), and ICU mortality (2.6%). AYAs had higher rates of CCCs than younger children (75% vs. 65%) but lower rates of mechanical ventilation (27% vs. 35%), parenteral nutrition (9.5% vs. 12.5%), and ECMO utilization (0.6% vs. 1.1%). Over time, annual PICU admissions increased across all age groups; however, AYA admissions increased by a greater percentage than younger peers (36% vs. 29%). Growth in admissions was principally driven by those with public insurance (53% vs. 28%) and CCCs (41% vs. 16%). Among AYAs with CCCs, technology dependence was the most prevalent CCC (44%); metabolic and gastrointestinal CCCs had the highest increase over time (162%, 99%, respectively).

Conclusions: While PICU admissions have grown across all age groups over the past decade, AYA PICU admissions are increasingly patients with CCCs and public insurance. Future investigations will evaluate the economic impact of the rising AYA population with CCCs.