Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample

Sriram Ramgopal, Julia A. Heneghan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods: We conducted a retrospective cross-sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Results: Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in-hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non-specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). Conclusions and Relevance: The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.

Original languageEnglish (US)
Article numbere12950
JournalJournal of the American College of Emergency Physicians Open
Issue number3
StatePublished - Jun 2023

Bibliographical note

Funding Information:
and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see The authors have stated that no such relationships existWe thank the Illinois Health and Hospital Association for the provision of data used in this study. Sriram Ramgopa is sponsored by PEDSnet (Department of Pediatrics, Northwestern University Feinberg School of Medicine). Sriram Ramgopal is funded by PEDSnet (Department of Pediatrics, Ann and Robert H Lurie Children's Hospital, Chicago IL).

Publisher Copyright:
© 2023 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.


  • children with medical complexity
  • complex chronic conditions
  • complex chronic disease
  • emergency care
  • pediatric medical complexity algorithm

PubMed: MeSH publication types

  • Journal Article


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