Determinants of Prolonged Hospitalization in Children and Adolescents: A Retrospective Observational Study

Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population. Observational, retrospective, monocentric study. A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3-18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS. Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (r = 0.262, p =