Identification and characteristics of children with complex chronic diseases in the paediatric ward of a tertiary hospital: a prospective study.

Authors

Laura García-Miralles, Marina Ortega-Macías, Cristina Agüera-MartÍn, Lorena López-González, Pablo Del Villar Guerra, Lucía B Ortiz SanRomán, Alfredo Cano

Published in

European journal of pediatrics. Volume 185. Issue 7. Jun 20, 2026. Epub Jun 20, 2026.

Abstract

Children with chronic and complex conditions (CCCC) are a population with a growing impact on healthcare. Several methods for their identification have been developed, but their performance requires further research. Our objective was to characterize hospitalizations due to CCCC and to compare two methods for identifying these patients on a hospital ward: one that requires a direct interview with the parents/caregivers (PedCom scale), and another based on clinical records (Parente algorithm). A prospective study was conducted over one year, including all children hospitalized > 24 h in a pediatric ward of a Spanish tertiary hospital. Children with special health needs (CSHN) were identified using a specific tool, the Children with Special Health Care Needs Screener, and among them, CCCC were identified by expert consensus. The performance and agreement of PedCom scale and Parente algorithm for identifying CCCC were compared. CSHN were identified in 22.7% of hospitalizations, and 23.3% of them were CCCC. CCCC accounted for 9.0% of all hospitalizations, and 13.3% of total hospital days. CCCC required longer hospital stays, more diagnostic and therapeutic procedures, and were more frequently transferred to other centers with a higher level of care, compared to CSHN no-CCCC. For the identification of CCCC, PedCom showed greater sensitivity (84.6%; 95%CI: 66.5-93.9) than Parente (34.6%; 95%CI: 19.4-53.8), with high specificity for both tools: 95.8% (95%CI: 88.3-98.6) and 100% (95%CI: 94.9-100.0), respectively. Agreement between PedCom and Parente was low-to-moderate (kappa 0.455; 95% CI: 0.211-0.699).
A high proportion of pediatric hospitalizations correspond to CCCC, with a greater consumption of healthcare resources. The PedCom scale performs much better in identifying CCCC than Parente's algorithm.
• The increasing prevalence of children with chronic and complex conditions (CCCC) poses a challenge to healthcare systems. Identifying these children is a key step in organizing health services.
• The PedCom scale has suitable characteristics for identifying hospitalized CCCC, and has a superior performance to the Parente algorithm.

PMID:
42322441
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.

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