Optimizing Pediatric Intermediate Care: Clinical Predictors of Deterioration and Length of Stay in a Tertiary Setting

<b>Background/Objective:</b> Pediatric Intermediate Care Units (PIMCUs) provide enhanced monitoring and support for children who require more care than standard wards but do not meet full Pediatric Intensive Care Unit (PICU) criteria. Despite their growing role, evidence on how to stratify risk and predict clinical trajectories within this specific population remains scarce. This study aimed to identify admission factors associated with (1) early unplanned transfer to the PICU within 48 h and (2) prolonged length of stay (LOS) in the PIMCU of a tertiary Italian pediatric hospital. <b>Methods:</b> We conducted a retrospective observational study including 893 children admitted to the PIMCU at IRCCS Gaslini Children's Hospital (Genoa, Italy) between January 2022 and June 2023. Demographic, clinical, laboratory, and outcome data were collected. Multivariable logistic regression and negative binomial models were used to assess predictors of early PICU transfer and prolonged LOS, respectively. <b>Results:</b> Early PICU transfer occurred in 2.8% of cases. Tachypnea (OR = 2.80; <i>p</i> = 0.018) and nasogastric tube (OR = 3.72; <i>p</i> = 0.014) at admission were independently associated with PICU transfer within 48 h. Prolonged LOS was significantly associated with the need for respiratory support and the presence of medical devices, including nasogastric tubes, central venous lines, and thoracic/abdominal drains. <b>Conclusions:</b> Specific clinical markers and device use at admission can help identify patients at higher risk of deterioration or extended PIMCU stay, supporting more accurate triage, early intervention, and resource optimization in pediatric intermediate care settings.