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Utilization of a pediatric observation unit for toxicologic ingestions.
Pediatr Emerg Care. 2012 Nov; 28(11):1169-72.PE

Abstract

OBJECTIVES

The objectives of this study were to evaluate the efficacy and utilization of an observation unit (OU) for admission of pediatric patients after a toxicologic ingestion; compare the characteristics and outcomes of patients admitted to the pediatric OU, inpatient (IP) service, and intensive care unit (ICU) after ingestions using retrospective chart review; and attempt to identify factors associated with unplanned IP admission after an OU admission.

METHODS

This was a retrospective chart review of children seen in the emergency department (ED) after potentially toxic suspected ingestions and then admitted to the OU, IP service, or ICU from June 2003 to September 2007.

RESULTS

One thousand twenty-three children were seen in the ED for ingestions: 18% were admitted to the OU, 15% to the IP service service, and 6% to the ICU. Observation unit patients had less mental status changes reported and were less frequently given medications while in the ED. Eighty-one percent of OU patients were admitted with poison center recommendation. Ninety-four percent of OU patients were discharged within 24 hours, and less than half of IP service/ICU patients were discharged that quickly. No significant associations were found between specific historical and physical examination or laboratory characteristics in the ED and the need for unplanned IP admission.

CONCLUSIONS

Observation unit patients admitted after ingestions were young, typically ingested substances found in the home, and required observation according to poison center recommendations. Ninety-four percent were able to be discharged home within 24 hours even after ingesting some of the most concerning substances such as central nervous system depressants, cardiac/antihypertension medications, hypoglycemics, and opiates. All OU patients did well without any adverse events reported. Many patients requiring prolonged observation after an ingestion, and who do not require ICU care, may be appropriate for OU management. This study suggests a potential underutilization of observation units in this setting.

Authors+Show Affiliations

Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. jenplumb@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23114240

Citation

Plumb, Jennifer, et al. "Utilization of a Pediatric Observation Unit for Toxicologic Ingestions." Pediatric Emergency Care, vol. 28, no. 11, 2012, pp. 1169-72.
Plumb J, Dudley NC, Herman BE, et al. Utilization of a pediatric observation unit for toxicologic ingestions. Pediatr Emerg Care. 2012;28(11):1169-72.
Plumb, J., Dudley, N. C., Herman, B. E., & Kadish, H. A. (2012). Utilization of a pediatric observation unit for toxicologic ingestions. Pediatric Emergency Care, 28(11), 1169-72. https://doi.org/10.1097/PEC.0b013e3182717329
Plumb J, et al. Utilization of a Pediatric Observation Unit for Toxicologic Ingestions. Pediatr Emerg Care. 2012;28(11):1169-72. PubMed PMID: 23114240.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utilization of a pediatric observation unit for toxicologic ingestions. AU - Plumb,Jennifer, AU - Dudley,Nanette C, AU - Herman,Bruce E, AU - Kadish,Howard A, PY - 2012/11/2/entrez PY - 2012/11/2/pubmed PY - 2013/5/10/medline SP - 1169 EP - 72 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 28 IS - 11 N2 - OBJECTIVES: The objectives of this study were to evaluate the efficacy and utilization of an observation unit (OU) for admission of pediatric patients after a toxicologic ingestion; compare the characteristics and outcomes of patients admitted to the pediatric OU, inpatient (IP) service, and intensive care unit (ICU) after ingestions using retrospective chart review; and attempt to identify factors associated with unplanned IP admission after an OU admission. METHODS: This was a retrospective chart review of children seen in the emergency department (ED) after potentially toxic suspected ingestions and then admitted to the OU, IP service, or ICU from June 2003 to September 2007. RESULTS: One thousand twenty-three children were seen in the ED for ingestions: 18% were admitted to the OU, 15% to the IP service service, and 6% to the ICU. Observation unit patients had less mental status changes reported and were less frequently given medications while in the ED. Eighty-one percent of OU patients were admitted with poison center recommendation. Ninety-four percent of OU patients were discharged within 24 hours, and less than half of IP service/ICU patients were discharged that quickly. No significant associations were found between specific historical and physical examination or laboratory characteristics in the ED and the need for unplanned IP admission. CONCLUSIONS: Observation unit patients admitted after ingestions were young, typically ingested substances found in the home, and required observation according to poison center recommendations. Ninety-four percent were able to be discharged home within 24 hours even after ingesting some of the most concerning substances such as central nervous system depressants, cardiac/antihypertension medications, hypoglycemics, and opiates. All OU patients did well without any adverse events reported. Many patients requiring prolonged observation after an ingestion, and who do not require ICU care, may be appropriate for OU management. This study suggests a potential underutilization of observation units in this setting. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/23114240/Utilization_of_a_pediatric_observation_unit_for_toxicologic_ingestions_ L2 - https://doi.org/10.1097/PEC.0b013e3182717329 DB - PRIME DP - Unbound Medicine ER -