Regionalization of Pediatric ICU Care for Children With Technology Dependence

Tuesday, March 24, 2026

8:55 AM - 9:55 AM Central Time

Location: Connections Central Theater 1

Allan M. Joseph, MD, MPH

Cincinnati Children's Hospital Medical Center, Ohio

Disclosure(s): No relevant financial relationship(s) to disclose.
Manzilat Akande, MD, MPH, MS (she/her/hers)

University of Oklahoma Health Sciences Center, Oklahoma

Disclosure information not submitted.
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Nadine Straka, MD, MPH (she/her/hers)

Boston Childrens Hospital, Oregon

Disclosure(s): No relevant financial relationship(s) to disclose.
Robert Graham, MD (he/him/his)

Boston Children’s Hospital, Massachusetts

Disclosure information not submitted.
Elizabeth Y. Killien, MD, MPH

Seattle Children's Hospital, Washington

Disclosure(s): No relevant financial relationship(s) to disclose.
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Mary Hartman, MD, MPH

Professor
Washington University in St. Louis

Disclosure information not submitted.
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Matthew Keller, MS

Research Consultant
Washington University in St. Louis)

Disclosure information not submitted.
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Karen Segar, MA

Research Consultant
University of Washington

Disclosure information not submitted.
JH

Julia A. Heneghan, MD, MS (she/her/hers)

University of Minnesota, Minnesota

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: Children with technology dependence (TD), including those who rely on home mechanical ventilation (HMV), account for a disproportionate share of pediatric intensive care unit (PICU) days. The impact of ongoing regionalization in pediatric hospital care on the care of children with TD is unknown. We aimed to describe the current state of regionalization in PICU care for children with TD, hypothesizing that this care is more regionalized than care for children without TD.

Methods: We used State Inpatient Databases from the Healthcare Cost & Utilization Project (HCUP) for 14 states in 2022 to identify ICU admissions for children with TD. We defined TD using the Chronic Complex Conditions 2.0 algorithm, and chronic ventilator dependence (HMV) using ICD-10-CM codes. We linked HCUP data to American Hospital Association data to calculate the distances patients traveled for ICU care. We defined pediatric capability as: Tier 1 (>10 ICU beds) and Tier 2 (≤10 PICU beds).

Results: There were 48,555 PICU admissions in 854 hospitals. Children with TD comprised 22.8% (n=11,092) of PICU admissions, of which 1,335 (12.0%) were for children with HMV. Previously healthy PICU patients traveled a median of 8 (IQR 4-24) miles from home for admission, while those with HMV traveled 11 (5–33) miles, and non-ventilator TD traveled 15 (7-45) miles. Over 83% (n=9,210) of PICU admissions for children with TD were in Tier 1 hospitals (n=35). Only 64/854 (7.5%) hospitals provided critical care services to children with HMV. For the 1,023 PICU admissions for children with TD in Tier 2 hospitals, Tier 1 hospitals were a median of 11 (4-14) miles farther away from patients’ homes than Tier 2 hospitals. Compared to children with TD admitted to Tier 2 hospitals, children with TD admitted to Tier 1 PICUs had higher rates of multiple organ dysfunction syndrome (39.0% vs 25.6%, p=0.001) and mortality (3.5% vs 1.7%, p=0.002).

Conclusions: Children with TD often receive ICU care in a small number of specialized hospitals. Children with TD admitted to Tier 1 hospitals have a higher illness severity and mortality compared to those admitted to Tier 2 pediatric hospitals. Together, these findings suggest that care for children with TD follows similar regionalization patterns, but to a greater extent, than care for children without TD.