The frequency and complexity of pediatric hospitalizations to pediatric and adult departments in Germany

BACKGROUND: Germany’s upcoming hospital reform aims to restructure inpatient services by assigning hospitals to defined “care groups” that determine which services they may provide in the future. While pediatric care will continue to receive infrastructural readiness funding, the reform eliminates a dedicated care group for specialized pediatric medicine. As a result, subspecialized pediatric services will no longer be distinctly designated or planned for. This has raised concerns about future access to specialized inpatient care for children and adolescents, given the complexity and diversity of pediatric conditions. The aim of this study was to contribute objective data to the ongoing debate by investigating how pediatric patients are distributed between pediatric (PD) and adult departments (AD) and assessing case complexity. METHODS: We conducted a retrospective observational study using data from the German nationwide hospital discharge dataset from 2016 to 2022, comprising all public hospitals. Hospitalized cases aged >28 days and