Retrospective Evaluation of Pediatric Emergency Department Visits of Children With Medical Complexity in a Tertiary Care Center in Italy

Objective: Children with medical complexity are a growing population with multiple conditions, medical device dependency and frequent need for emergency department (ED) visits; their care and management in an emergency setting may be challenging. The pediatric palliative care (PPC) network aims to address the needs of these children and their families to improve their quality of life. The purpose of this retrospective single-center study was to determine the prevalence and reasons for visiting the ED, the management, outcome, and quality of care received in a Tertiary Care Pediatric Hospital, where the PPC facility is strongly integrated and cooperating with the ED. Methods: We collected data on the 775 pediatric ED visits performed in Padua Pediatric ED between 2006 and 2023 by 85 children under the care of the regional center for PPC in Veneto, Italy. Results: Median number of visits per patient was 2.0 per year, 33.4% resulting in hospital admissions. Most frequent reasons for ED visits were respiratory conditions (28.9%), followed by medical device malfunctions (18.3%). Other data included PPC specialist involvement, ED referral, time of arrival, color code, and type of assistance required. Over the years, there has been an increased number of ED visits, admissions, medical device malfunctions, hours spent in the ED, and involvement of PPC specialists. No significant influences were noted during the COVID-19 pandemic period. Conclusion: These data highlight potential areas of intervention to enhance emergency care management for CMC, such as early PPC specialist involvement with the home care network activation, a specific training of ED providers, and a dedicated service for the management of device malfunctions.