Children with complex chronic diseases (C-CDs) and life-limiting conditions (LLCs) account for a disproportionate share of pediatric hospital admissions and resource use, according to a new retrospective study conducted in the Basque Public Health System. The analysis, spanning 2018 to 2020, reveals that while only a minority of pediatric patients had C-CDs or LLCs, these groups were responsible for over 29% of total hospital admissions and the majority of in-hospital deaths.
Drawing from 34,555 pediatric admissions involving 26,196 patients, researchers identified those with C-CDs using the Pediatric Medical Complexity Algorithm and those with LLCs using the Hain Directory of Life-Limiting Conditions. Patients with C-CDs represented 15.4% of admissions, while those with LLCs comprised 14.4%. These populations exhibited significantly higher frequencies and durations of both general and intensive care unit admissions compared to children without these conditions.
Children with LLCs, in particular, showed a greater need for advanced interventions such as respiratory or hemodynamic support and device placement. The study also found that eight out of ten pediatric in-hospital deaths occurred among patients with C-CDs and/or LLCs, with LLC patients experiencing the highest mortality risk.
This overlap in diagnostic categories suggests that both definitions identify children who are not only medically fragile but also highly reliant on intensive healthcare services. The findings emphasize the need for healthcare systems, especially publicly insured ones, to plan targeted interventions and resource allocation strategies for this vulnerable group.
The authors advocate for further research into the financial implications of caring for children with C-CDs and LLCs, noting that the high burden they place on hospital systems calls for both improved care models and sustainable funding structures.
Reference:
Serrano-Pejenaute I et al. Impact of complex chronic diseases and life-limiting condition status on paediatric hospitalization: observational study. Eur J Pediatr. 2025;184(6):378. doi: 10.1007/s00431-025-06227-0.
