Utility of a pediatric observation unit for the management of children admitted to the emergency department

Abstract

Background Observation Units (OU), as part of emergency department (ED), are areas reserved for short-term treatment or observation of patients with selected diagnoses to determine the need for hospitalization or home referral. Methods In this retrospective cohort study, we analyzed similarities and differences of children admitted to the pediatric ED of the Fondazione Policlinico Universitario A. Gemelli IRCCS hospital in the first 2 years of OU activity, analyzing general patient characteristics, access modalities, diagnosis, triage, laboratory and instrumental examinations, specialist visits, outcome of OU admission and average time spent in OU. Furthermore, we compared total numbers and type of hospitalization of the first 2 years of OU activity with those of previous 2 years. Results The most frequent diagnoses were abdominal pain, minor head injury without loss of consciousness, vomiting, epilepsy and acute bronchiolitis. The most performed laboratory examinations were blood count. The most commonly performed instrumental examination was abdominal ultrasound. Neurological counseling was the most commonly requested. Average time spent in OU was 13 h in 2016 and 14.1 h in 2017. Most OU admissions did not last longer than 24 h (90.5% in 2016 and 89.5% in 2017). In the years 2014–2015, 13.4% of pediatric patients accessing the ED were hospitalized, versus 9.9% the years 2016–2017 reducing pediatric hospital admissions by 3.6% (p < 0.001). Conclusions This study demonstrate that OU is a valid alternative to ordinary wards for specific pathologies. In accordance with the literature, our study showed that, in the first 2 years of the OU activity, admissions to hospital ward decreased compared with the previous 2 years with an increase of complex patients.

PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department

“…In fact, in this group, ED physicians should perform initial observation over CT scan, especially in the presence of isolated findings, no worsening of symptoms, and a child older than 3 months. Indeed, our results demonstrated that all 8 patients with ciTBI in this risk category had worsening of symptoms during clinical observation [9,16]. This is also confirmed by a secondary analysis of the PECARN head injury parent study which showed that clinical observation before CT decision-making resulted in a safe and potentially effective strategy to manage a subset of children with MHI.…”

“…Our study performed in an Italian pediatric ED confirmed the efficacy and safety of the PR in detecting the presence of ciTBI in patients with MHI, reducing radiological investigations and exposure to ionizing radiations. In literature, different authors proposed clinical algorithms to optimize management of pediatric patients with MHI but the PR seems to have the best methodological quality [6][7][8][9][10][11][12][13][14][15][16].…”

IBI Score to Improve Clinical Practice in Newborns and Infants ≤ 60 Days with Fever in the Emergency Department

“…In the present study, stratifying patients by IBI score, 44 (26.5%) were with score (0-1) and none had a positive blood culture. Even if accepting a cautious approach for patients with low-risk IBI score and negative inflammatory markers (11 in the present series), in the remaining 33 (19.9%) invasive diagnostic procedures, broad-spectrum antibiotic therapies, and hospitalization days could be spared also with an admission to OU for 24 h [10].…”

Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department

“…Besides, 17 (5.9%) patients had been transferred to the Observation Unit (OU) [ 13 ]. The average time spent in OU was 12 h, 7/17 (41%) of these patients underwent endoscopic surgery for foreign body removal, 5/17 (29%) patients had been discharged, 5/17 (29%) patients in OU were hospitalized: two of them subsequently underwent endoscopic removal of the foreign body and three were clinically observed.…”