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Use of an observation unit by a pediatric emergency department for common pediatric illnesses.
Pediatr Emerg Care. 2001 Oct; 17(5):321-3.PE

Abstract

OBJECTIVE

To describe the use of a pediatric observation unit (OU), including relapse rates for common pediatric illnesses, and to assess effectiveness of OU utilization.

DESIGN

Retrospective, cohort of all emergency department (ED) visits, OU and inpatient unit (IU) admissions.

SETTING

Tertiary care children's hospital.

PARTICIPANTS

All children evaluated in the ED and subsequently admitted to either the OU or IU over a 2-year period.

MAIN OUTCOME MEASURE

Rates with 95% confidence intervals (CI) for OU use and need for subsequent IU admission from OU, and odds ratios (OR) with 95% CI for use of the OU for specific pediatric disorders.

RESULTS

During 10/1/96-9/30/98, there were 44,459 ED visits, 1798 (4.0%) OU admissions, and 3241 (7.3%) inpatient admissions (IA) from the ED. OU mean length of stay was 15.6 +/- 6.1 hours; mean age was 6 +/- 5.3 years with 31% under 2 years of age. Of the total admissions (IU and OU), diagnoses with high OU utilization were: asthma 274/575, 48%; croup 76/125, 61%; enteritis/dehydration 284/470, 60%; poisonings 82/118, 70%; and seizures 80/204, 39%. The likelihood of an OU admission for these illnesses versus IU (adjusted for subsequent need for IU admission) was: asthma OR 1.3 (1.1, 1.5), P < 0.005; croup OR 2.3 (1.6, 3.3), <0.001; enteritis/ dehydration OR 2.8 (2.1, 3.0), P < 0.001; poisonings OR 3.8 (2.5, 5.7), P < 0.001; and seizures OR 0.8 (0.6, 1.2), P = 0.28. For these diagnoses, OU admissions resulting in IU admission occurred for asthma 45/274, 16.4%; croup 7/76, 9.2%; enteritis/ dehydration 13/284, 4.6%; poisonings 3/82, 3.7%; and seizures 15/80, 18.8%, resulting in an overall need for further hospitalization to the IU for these diagnoses of 83/796, 10.4%, (95% CI 8.3, 12.6).

CONCLUSION

Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to be well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admissions, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients.

Authors+Show Affiliations

Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA. pscriba@ccmckids.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11673706

Citation

Scribano, P V., et al. "Use of an Observation Unit By a Pediatric Emergency Department for Common Pediatric Illnesses." Pediatric Emergency Care, vol. 17, no. 5, 2001, pp. 321-3.
Scribano PV, Wiley JF, Platt K. Use of an observation unit by a pediatric emergency department for common pediatric illnesses. Pediatr Emerg Care. 2001;17(5):321-3.
Scribano, P. V., Wiley, J. F., & Platt, K. (2001). Use of an observation unit by a pediatric emergency department for common pediatric illnesses. Pediatric Emergency Care, 17(5), 321-3.
Scribano PV, Wiley JF, Platt K. Use of an Observation Unit By a Pediatric Emergency Department for Common Pediatric Illnesses. Pediatr Emerg Care. 2001;17(5):321-3. PubMed PMID: 11673706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of an observation unit by a pediatric emergency department for common pediatric illnesses. AU - Scribano,P V, AU - Wiley,J F,2nd AU - Platt,K, PY - 2001/10/24/pubmed PY - 2002/3/30/medline PY - 2001/10/24/entrez SP - 321 EP - 3 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 17 IS - 5 N2 - OBJECTIVE: To describe the use of a pediatric observation unit (OU), including relapse rates for common pediatric illnesses, and to assess effectiveness of OU utilization. DESIGN: Retrospective, cohort of all emergency department (ED) visits, OU and inpatient unit (IU) admissions. SETTING: Tertiary care children's hospital. PARTICIPANTS: All children evaluated in the ED and subsequently admitted to either the OU or IU over a 2-year period. MAIN OUTCOME MEASURE: Rates with 95% confidence intervals (CI) for OU use and need for subsequent IU admission from OU, and odds ratios (OR) with 95% CI for use of the OU for specific pediatric disorders. RESULTS: During 10/1/96-9/30/98, there were 44,459 ED visits, 1798 (4.0%) OU admissions, and 3241 (7.3%) inpatient admissions (IA) from the ED. OU mean length of stay was 15.6 +/- 6.1 hours; mean age was 6 +/- 5.3 years with 31% under 2 years of age. Of the total admissions (IU and OU), diagnoses with high OU utilization were: asthma 274/575, 48%; croup 76/125, 61%; enteritis/dehydration 284/470, 60%; poisonings 82/118, 70%; and seizures 80/204, 39%. The likelihood of an OU admission for these illnesses versus IU (adjusted for subsequent need for IU admission) was: asthma OR 1.3 (1.1, 1.5), P < 0.005; croup OR 2.3 (1.6, 3.3), <0.001; enteritis/ dehydration OR 2.8 (2.1, 3.0), P < 0.001; poisonings OR 3.8 (2.5, 5.7), P < 0.001; and seizures OR 0.8 (0.6, 1.2), P = 0.28. For these diagnoses, OU admissions resulting in IU admission occurred for asthma 45/274, 16.4%; croup 7/76, 9.2%; enteritis/ dehydration 13/284, 4.6%; poisonings 3/82, 3.7%; and seizures 15/80, 18.8%, resulting in an overall need for further hospitalization to the IU for these diagnoses of 83/796, 10.4%, (95% CI 8.3, 12.6). CONCLUSION: Admissions to the observation unit comprised over one third of all admissions from a pediatric ED. Certain pediatric illnesses appear to be well suited for admission to the observation unit, with low likelihood of the need for subsequent admission to the inpatient unit. Given the current trends in third-party payer reimbursements for short (<24 hours) admissions, observation unit use provides a more attractive alternative to inpatient admission for many pediatric patients. SN - 0749-5161 UR - https://www.unboundmedicine.com/medline/citation/11673706/Use_of_an_observation_unit_by_a_pediatric_emergency_department_for_common_pediatric_illnesses_ L2 - https://doi.org/10.1097/00006565-200110000-00001 DB - PRIME DP - Unbound Medicine ER -