Observation units (OUs) serve patients who require more evaluation or treatment than possible during an emergency department visit and who are anticipated to stay in the hospital for a short defined period. Asthma is a common admission diagnosis in a pediatric OU. Our main objective was to identify clinical factors associated with failure to discharge a child with asthma from our OU within 24 hours.
Retrospective chart review at a tertiary care children's hospital. Participants were children 2 years or older with asthma admitted from the emergency department to the OU during August 1999 to August 2001. The OU-discharged group comprised those successfully discharged from the OU within 24 hours. The unplanned inpatient admission group comprised those subsequently admitted from the OU to a traditional inpatient ward or those readmitted to the hospital within 48 hours of OU discharge.
One hundred sixty-one children aged 2 to 20 years (median 4.0; 63% boys) met inclusion criteria; 40 patients (25%) required unplanned inpatient admission. In a multiple logistic regression model, 3 factors were associated with need for unplanned inpatient admission: female sex (adjusted odds ratio, 2.6; 95% confidence interval, 1.1-6.4; P = 0.03), temperature 38.5 degrees C or higher (adjusted odds ratio, 6.1; 95% confidence interval, 1.6-23.5; P < 0.01), and need for supplemental oxygen at the end of emergency department management (adjusted odds ratio, 5; 95% confidence interval, 1.7-15.1; P < 0.01).
Many children with asthma can be admitted to a pediatric OU and discharged safely within 24 hours. Prospective studies are needed to confirm our findings and to identify other factors predictive of unplanned inpatient admission.