Development of a Medical Complexity Score for Pediatric Aerodigestive Patients

Abstract

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