Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Hank T Puls
Presentation Type
Poster
Start Date
20-5-2026 12:00 PM
End Date
20-5-2026 1:00 PM
Abstract Text
Background:
Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood for children with medical complexity increases, children’s hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population.
Objective:
Compare characteristics of adults and adolescents with HINI hospitalized at children’s hospitals and describe hospital-level variation in hospitalizations for adults with HINI.
Methods:
This was a retrospective cross-sectional study of hospitalizations for patients with HINI aged 12-29 years discharged from 43 children’s hospitals in the Pediatric Health Information System during 2022-24. Hospitals where adult encounters were at birthing centers were excluded. Discharges were categorized by age: adolescents (12-17 years) and adults (18-29 years). Chi-square and Wilcoxon Rank-Sum tests compared the two groups by hospitalization level characteristics, intensive care use, hospital length of stay, in-hospital mortality, and mean cost of hospitalization. HINI combinations were quantified for each group and ordered by prevalence. Hospital-level variation was described using the percentage of included HINI discharges that were adults and correlated with hospital volume of included HINI discharges using Pearson’s coefficient. Age distribution also described by percentage of discharges at each age from the cohort and each hospital individually.
Results:
There were 136,290 hospitalizations included, 23.6% were adults. Compared to adolescents, adults were more likely to have >1 HINI category (41.1% vs 33.9%), a co-morbid non-neurologic CCC (72.5% vs 58.5%), and technology use (49.2% vs 37.8%). There were several different combinations of HINI categories. Epilepsy alone was more prevalent in adolescents while epilepsy+static was more common in adults. Adults had slightly longer length of stay, similar ICU use, similar mortality, and higher hospitalization costs. There was substantial hospital-level variation in the percentage of included HINI hospitalizations that were adults (range 0.0% to 35.7%), which was correlated with hospital volume of all HI-NI discharges aged 12-29 years (p=0.009). The prevalence of age remained steady until age 18 where it began to decrease significantly until the age of 21 and gradually tailed off to age 29.
Conclusions:
Adults with HINI were more complex and incurred longer hospitalizations and greater inpatient costs than their adolescent counterparts. Hospital-level variation in adults with HINI hospitalized at children’s hospitals was partially correlated with hospital volume of HINI discharges and may result from differences in the transition processes between institutions. Future studies should seek to understand optimal transition timing and care setting for these patients.
Adults and Adolescents with High Intensity Neurologic Impairment Hospitalized at Children’s Hospitals
Background:
Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood for children with medical complexity increases, children’s hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population.
Objective:
Compare characteristics of adults and adolescents with HINI hospitalized at children’s hospitals and describe hospital-level variation in hospitalizations for adults with HINI.
Methods:
This was a retrospective cross-sectional study of hospitalizations for patients with HINI aged 12-29 years discharged from 43 children’s hospitals in the Pediatric Health Information System during 2022-24. Hospitals where adult encounters were at birthing centers were excluded. Discharges were categorized by age: adolescents (12-17 years) and adults (18-29 years). Chi-square and Wilcoxon Rank-Sum tests compared the two groups by hospitalization level characteristics, intensive care use, hospital length of stay, in-hospital mortality, and mean cost of hospitalization. HINI combinations were quantified for each group and ordered by prevalence. Hospital-level variation was described using the percentage of included HINI discharges that were adults and correlated with hospital volume of included HINI discharges using Pearson’s coefficient. Age distribution also described by percentage of discharges at each age from the cohort and each hospital individually.
Results:
There were 136,290 hospitalizations included, 23.6% were adults. Compared to adolescents, adults were more likely to have >1 HINI category (41.1% vs 33.9%), a co-morbid non-neurologic CCC (72.5% vs 58.5%), and technology use (49.2% vs 37.8%). There were several different combinations of HINI categories. Epilepsy alone was more prevalent in adolescents while epilepsy+static was more common in adults. Adults had slightly longer length of stay, similar ICU use, similar mortality, and higher hospitalization costs. There was substantial hospital-level variation in the percentage of included HINI hospitalizations that were adults (range 0.0% to 35.7%), which was correlated with hospital volume of all HI-NI discharges aged 12-29 years (p=0.009). The prevalence of age remained steady until age 18 where it began to decrease significantly until the age of 21 and gradually tailed off to age 29.
Conclusions:
Adults with HINI were more complex and incurred longer hospitalizations and greater inpatient costs than their adolescent counterparts. Hospital-level variation in adults with HINI hospitalized at children’s hospitals was partially correlated with hospital volume of HINI discharges and may result from differences in the transition processes between institutions. Future studies should seek to understand optimal transition timing and care setting for these patients.
Comments
Poster Board Number: 8