Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

Abstract

Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

“…A more aggressive course and disease flares associated with higher morbidity and mortality rates have been reported at diagnosis and follow-up in cSLE patients compared with adult-onset SLE. Indeed, cSLE patients had a higher prevalence of initial and cumulative multiorgan system involvement, such as nephritis, neuropsychiatric, hematological, and macrophage activation syndrome, than adult-onset SLE patients [13,[25][26][27][28][29][30][31][32][33][34][35]. In contrast, late-onset SLE (> 50 years) patients had the lowest prevalence of constitutional and mucocutaneous manifestations, serositis, and hypocomplementemia compared with cSLE and adult-onset SLE [36].…”

Intermittent abdominal pain in IgA vasculitis

“…The advantage of the present study was the selection of this population followed in a tertiary center in Latin America with predominance of complex patients. 17 Furthermore, all subjects fulfilled the validated EULAR/PRINTO/PRES classification criteria 6 and were systematically assessed according to our standardized database, as previously reported. 1 , 2 …”

Spiritual Needs of Brazilian Children and Adolescents with Chronic Illnesses: A Thematic Analysis

“…The prevalence of children and adolescents living with chronic diseases has increased in the past 50 years (Passone et al, 2020;Perrin et al, 2014). Currently, it is possible to perform detection, early diagnosis and treatment of many diseases in children and adolescents, which previously were fatal.…”

“…Currently, it is possible to perform detection, early diagnosis and treatment of many diseases in children and adolescents, which previously were fatal. Thus, the increase in survival has critical implications resulting from chronicity (Passone et al, 2020). Diseases such as cancer, type 1 diabetes mellitus (DM1) and cystic fibrosis, are common in childhood and demand daily care for long term periods (Mokkink et al, 2008).…”