A Retrospective Study on the Evolution of Complex Chronic Conditions Over a Decade in a Large Swiss Tertiary PICU

Objectives: To examine, over a 10-year period, changes in the prevalence of complex chronic conditions (CCCs) and in the distribution of underlying chronic health categories within a large Swiss PICU, and to compare patient characteristics and PICU mortality between children with CCCs and those without. Design: Single-center retrospective observational study of two cohorts (2007 vs. 2017). Setting: Large academic tertiary referral PICU. Patients: Overall, 1867 children were included (0–16 years old): 981 admitted between January 1, 2007, and December 31, 2007, and 886 admitted between January 1, 2017, and December 31, 2017. Interventions: None. Measurements and Main Results: The prevalence of children with CCCs increased from 61% in 2007 to 70% in 2017. The most common conditions were cardiovascular (55% in 2007 vs. 52% in 2017), congenital/genetic defects (36% vs. 38%), and neurologic/neuromuscular (25% vs. 34%). The proportion of children with 3 or more chronic conditions rose from 16% to 25%. Children with CCCs had longer PICU stays than children without, with length of stay increasing significantly with the number of CCCs. Most children who died during the two study periods had a chronic condition (2007: 61%; 2017: 66%), with a significant increase in the proportion of deaths following intensive care treatment withdrawal (8% in 2007 vs. 48% in 2017). Conclusions: Over a decade, the proportion of children with CCCs needing PICU care has grown, with trends toward increasing prevalence in the clinically dominant categories of respiratory and hematology, immunodeficiency, and immunology, and the subcategories respiratory malformations , hereditary hemostasis anomalies, and home ventilation , and trends toward higher mortality rates following treatment withdrawal.