Pediatric Intermediate Care: Analysis of Patient Flows and Outcomes at the University Hospital of Padova

ABSTRACT Background: Pediatric Intermediate Care Units (PIMCUs) have emerged as a critical component in the continuum of care for children requiring close monitoring and medical intervention beyond the capacities of general pediatric wards, but not intensive enough to necessitate Pediatric Intensive Care Unit (PICU) admission. Despite their growing relevance, data on their structure, patient populations, and clinical outcomes remain limited. Aim of the study: This study aimed to describe the clinical characteristics, patient flow, interventions, and outcomes in the PIMCU of the University Hospital of Padova, over a 14-month period. Materials and methods: A retrospective observational analysis was conducted on pediatric patients aged 0–18 years admitted to the PIMCU from November 2023 to December 2024. Demographic data, comorbidities, admission source, diagnoses, interventions, Pediatric Early Warning Scores (PEWS), and clinical outcomes were analyzed. Patients were categorized as “step-up” (from Emergency Department/wards) or “step-down” (from PICU/NICU). Results: Of the 1193 admissions to the Acute Patient Ward, 242 (20%) were managed in the PIMCU. Step-up admissions accounted for 85% of cases. Acute respiratory conditions (notably pneumonia and bronchiolitis) were the leading causes of admission. Half of the patients had comorbidities, with congenital heart disease and epileptic encephalopathy being the most common. The median length of stay was six days, IQR 4-9. Only 21 patients (9%) required escalation to PICU, 2 of whom died during their PICU stay. Most patients (66.5%) were discharged home. Conclusions: The implementation of a PIMCU within a tertiary pediatric hospital allowed to manage high-acuity patients, minimizing unnecessary PICU admissions, and supporting early interventions for clinical deterioration. These findings support the integration of PIMCUs into pediatric care networks and highlight the need for 2 standardized protocols and procedures to optimize their structure and utilization within the more complex local institutional framework of pediatric urgent and critical care.