Estratificación de la complejidad en niños con enfermedad crónica y complejidad: estudio retrospectivo

Abstract

Introduction

Advances in medical care have increased the survival of children with chronic diseases, resulting in a growing population of patients with paediatric chronic complex conditions (PCCCs). The heterogeneity in the used terminology and identification tools hampers consistent stratification and appropriate planning of health care resources.

Objective

To determine the level of complexity in pediatric patients with chronic conditions using validated tools.

Material and methods

We conducted a retrospective cross-sectional study in a representative sample of paediatric patients with chronic conditions documented in the administrative records from the Community of Madrid in 2023. We collected data on sociodemographic variables and the main diagnosis according to the ICD-10. A sequential stratification process was applied using the Pediatric Medical Complexity Algorithm (PMCA), followed by the PedCom scale in patients classified as having PCCCs with the PMCA. We analyzed differences in patient categorization between the two tools and the variation in complexity according to the primary diagnosis.

Results

The analysis included a total of 355 patients with a median age of 8.1 years, of who 41.4% were female. According to the PMCA, 66.2% of patients were classified as having PCCCs. In this group, only 49.3% met the criteria for PCCCs using the PedCom scale. There was substantial varition in PedCom scores among patients sharing the same primary diagnosis.

Conclusions

Complexity in pediatric chronic conditions does not depend solely on the main diagnosis but on multiple clinical and psychosocial factors. The combined use of tools such as the PMCA and the PedCom may improve identification of children with greater complexity and support more tailored health care planning.