BACKGROUND: As more efficient and value‐based care models are sought for the US healthcare system, geographically distinct observation units (OUs) may become an integral part of hospital‐based care for children. PURPOSE: To systematically review the literature and evaluate the structure and function of pediatric OUs in the United States. DATA SOURCES: Searches were conducted in Medline, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Care Advisory Board (HCAB), Lexis‐Nexis, National Guideline Clearinghouse, and Cochrane Reviews, through February 2009, with review of select bibliographies. STUDY SELECTION: English language peer‐reviewed publications on pediatric OU care in the United States. DATA EXTRACTION: Two authors independently determined study eligibility. Studies were graded using a 5‐level quality assessment tool. Data were extracted using a standardized form. DATA SYNTHESIS: A total of 21 studies met inclusion criteria: 2 randomized trials, 2 prospective observational, 12 retrospective cohort, 2 before and after, and 3 descriptive studies. Studies present data on more than 22,000 children cared for in OUs, most at large academic centers. This systematic review provides a descriptive overview of the structure and function of pediatric OUs in the United States. Despite seemingly straightforward outcomes for OU care, significant heterogeneity in the reporting of length of stay, admission rates, return visit rates, and costs precluded our ability to conduct meta‐analyses. We propose standard outcome measures and future directions for pediatric OU research. CONCLUSIONS: Future research using consistent outcome measures will be critical to determining whether OUs can improve the quality and cost of providing care to children requiring observation‐length stays. Journal of Hospital Medicine 2010;5:172–182. © 2010 Society of Hospital Medicine.

OBJECTIVE-Brief hospitalizations for children may constitute an opportunity to provide care in an alternative setting such as an observation unit. The goal of this study was to characterize recent national trends in brief inpatient stays for children in the United States.METHODS-Using the Nationwide Inpatient Sample from 1993-2003, we analyzed hospital discharges among children <18 years of age, excluding births, deaths, and transfers. Hospitalizations with lengths of stay of 0 and 1 night were designated as "high turnover." Serial cross-sectional analyses were conducted to compare the proportion of high-turnover stays across and within years according to patient and hospital-level characteristics. Diagnosis-related groups and hospital charges associated with these observation-length stays were examined. RESULTS-In 2003, there were an estimated 441 363 high-turnover hospitalizations compared with 388 701 in 1993. The proportion of high-turnover stays increased from 24.9% in 1993 to 29.9% in 1999 and has remained ≥30.0% since that time. Diagnosis-related groups for high-turnover stays reflect common pediatric medical and surgical conditions requiring hospitalization, including respiratory illness, gastrointestinal/metabolic disorders, seizure/headache, and appendectomy. Significant increases in the proportion of high-turnover stays during the study period were noted across patient and hospital-level characteristics, including age group, payer, hospital location, teaching status, bed size, and admission source. High-turnover stays contributed $1.3 billion (22%) to aggregate hospital charges in 2003, an increase from $494 million (12%) in 1993. CONCLUSIONS-Consistently since 1999, nearly one third of children hospitalized in the UnitedStates experience a high-turnover stay. These high-turnover cases constitute hospitalizations, that may be eligible for care in an alternative setting. Observation units provide 1 model for an efficient and cost-effective alternative to inpatient care, in which resources and provider interactions with patients and each other are geared toward shorter stays with more timely discharge processes. Observation units have widespread use in adult emergency medicine, demonstrating a strong track record with shorter stays and reduced ward admission rates for common conditions such as chest pain, asthma, and cellulitis. [12][13][14][15][16][17][18] Work from McConnochie et al [19][20][21] in the 1990s indicated that a significant number of pediatric hospitalizations could be cared for in an alternative setting, such as an observation unit. Individual institutions have been successful in using pediatric observation units to decrease LOS, 2,4,9,22 reduce admission rates, 5,10,23 and control costs. 2,9 However, little is known about the potential at the national level for children to receive care in an observation unit setting. KeywordsIn this study, we used the Nationwide Inpatient Sample (NIS) over a period of 1 decade to provide national estimates of the number of US children who experi...

A DNA glycosylase that excises 7-methylguanines with alkali-opened imidazole rings (formamidopyrimidines) from DNA has been purified more than 8000-fold from Escherichia coli cell extracts. The enzyme does not cleave 3-methyladenine, uracil, and intact 7-methylguanine from DNA. In assays containing pyrimidine analogues like oxauracil, 2,4,6-triaminopyrimidine, 2,5,6-triamino-2-hydroxypyrimidine sulfate, formamidopyrimidine, and 5-nitroso-2,4,6-triaminopyrimidine, only the two compounds showed end product inhibition of the enzyme. The enzyme has been named formamidopyrimidine-DNA glycosylase. It has a molecular weight of 30 000 and a Stokes radius of 26.4 A. The enzyme prefers double-stranded to single-stranded DNA and is stimulated by the presence of 0.1 M KCl in the reaction mixture.

The ongoing spread of H5N1 avian influenza in Southeast Asia has raised concern about a worldwide influenza pandemic and has made clear the need to plan in advance for such an event. The federal government has stressed the importance of planning and, in particular, has asked hospitals and public health agencies to develop plans to care for patients outside of traditional healthcare settings. These alternative or acute care centers (ACCs) would be opened when hospitals, emergency departments (EDs), and clinics are overwhelmed by an influenza pandemic. The University of Michigan Hospital System (UMHS), a large tertiary care center in southeast Michigan, has been developing a model for offsite care of patients during an influenza pandemic. This article summarizes our planning efforts and the lessons learned from 2 functional exercises over the past 3 years.

Rectal MXT compares favorably to other methods of nonintravenous sedation for CT scanning of stable pediatric ED patients in terms of rapidity of onset and reliability but does cause a significant amount of transient respiratory depression. Its use requires careful monitoring of oxygen saturation and should be used only in a setting where physicians skilled in airway management are present. If these requirements are met, it may be a good choice for the relatively noninvasive sedation of pediatric ED patients undergoing painless but anxiety-provoking procedures.methohexital, pediatric procedure sedation, rectal administration, computerized tomography imaging.

ABSTRACTObjective: The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations.Methods: We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, “child+multiple organ failure + scoring system. ” Searches were conducted in the period January 2010-February 2010.Results: Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol.Conclusions: We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients.(Disaster Med Public Health Preparedness. 2012;6:131–137)

Before the H1N1 pandemic, greater than 40% of the hospitals in our study did not have an influenza pandemic preparedness plan. Many had to modify their existing plans during the surge. Not all institutions fully complied with CDC guidelines. Data from this multicenter survey should assist clinical leaders to create more robust surge plans for children.

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