Development of a Medical Complexity Score for Pediatric Aerodigestive Patients

Henry M Horita; Tzyynong L Friesen; Gabrielle Cahill; Hailey Brigger; Aparna Rao; Soma Kumar; Thu Elizabeth Duong; Kimberly Morris; Lisa Horvay; Virginia Floco; Matthew T Brigger

doi:10.1016/j.jpeds.2023.113549

Development of a Medical Complexity Score for Pediatric Aerodigestive Patients

J Pediatr. 2023 Oct:261:113549. doi: 10.1016/j.jpeds.2023.113549. Epub 2023 Jun 8.

Authors

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of California San Diego, San Diego, CA. Electronic address: hmhorita@health.ucsd.edu.
² Department of Otolaryngology - Head and Neck Surgery, University of California San Diego, San Diego, CA; Division of Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA.
³ Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA.
⁴ Department of Otolaryngology - Head and Neck Surgery, University of California San Diego, San Diego, CA.
⁵ Division of Pulmonology, Rady Children's Hospital San Diego, San Diego, CA.
⁶ Division of Gastroenterology, Rady Children's Hospital San Diego, San Diego, CA.
⁷ Department of Speech Language Pathology, Rady Children's Hospital San Diego, San Diego, CA.
⁸ Department of Occupational Therapy, Rady Children's Hospital San Diego, San Diego, CA.
⁹ Division of Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA.

PMID: 37301281
DOI: 10.1016/j.jpeds.2023.113549

Abstract

Objective: To develop a complexity scoring system to characterize the diverse population served in pediatric aerodigestive clinics and help predict their treatment outcomes.

Study design: A 7-point medical complexity score was developed through an iterative group consensus of relative stakeholders to capture the spectrum of comorbidities among the aerodigestive population. One point was assigned for each comorbid diagnosis in the following categories: airway anomaly, neurologic, cardiac, respiratory, gastrointestinal, genetic diagnoses, and prematurity. A retrospective chart review was conducted of patients seen in the aerodigestive clinic who had ≥2 visits between 2017 and 2021. The predictive value of the complexity score for the selected outcome of feeding progression among children with dysphagia was analyzed with univariate and multivariable logistic regression.

Results: We analyzed 234 patients with complexity scores assigned, showing a normal distribution (Shapiro Wilk P = .406) of the scores 1-7 (median, 4; mean, 3.50 ± 1.47). In children with dysphagia, there was waning success in the improvement of oral feeding with increasing complexity scores (OR, 0.66; 95% CI, 0.51-0.84; P = .001). Tube-fed children with higher complexity scores were incrementally less likely to achieve full oral diet (OR, 0.60; 95% CI, 0.40-0.89; P = .01). On multivariable analysis, neurologic comorbidity (OR, 0.26; P < .001) and airway malformation (OR, 0.35; P = .01) were associated with a decreased likelihood to improve in oral feeding.

Conclusions: We propose a novel complexity score for the pediatric aerodigestive population that is easy to use, successfully stratifies diverse presentations, and shows promise as a predictive tool to assist in counseling and resource use.

Keywords: complexity score; dysphagia; medical comorbidity; pediatric aerodigestive clinic; risk stratification.

MeSH terms

Ambulatory Care Facilities
Child
Comorbidity
Deglutition Disorders* / diagnosis
Deglutition Disorders* / epidemiology
Enteral Nutrition
Humans
Retrospective Studies