Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.
Department of Emergency Medicine, Harvard Medical School, Boston, MA.
Pediatr Emerg Care. 2024 Sep 1;40(9):627-631. doi: 10.1097/PEC.0000000000003174. Epub 2024 Apr 12.
Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated.
In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model.
One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7-27.1) for observation and 43.2 hours (95% CI, 37.8-48.6) for inpatient ( P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0-38.6) for observation and 48.1 hours (95% CI, 42.2-54.0) for inpatient ( P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07-2.42) fold shorter time to discharge among children admitted to observation compared with inpatient ( P = 0.02) and a 1.70 (95% CI, 1.07-2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses ( P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department.
These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.
许多需要住院的儿童都是儿科观察病房（POU）而不是儿科住院病房的理想护理人选。在这两种实践环境中接受护理的儿童的结果差异尚未得到全面评估。
在这项回顾性队列研究中，在社区医院的 POU 或儿童医院的住院病房入院的年龄在 0 至 18 岁的儿童，如果符合特定的临床标准，将被纳入研究。收集了关于当前疾病、病史和住院过程的信息。住院时间（LOS）是作为主要结果进行分析的；次要结果包括 POU 组转为住院治疗和 7 天内返回儿科急诊室。对患有呼吸道疾病的儿童进行亚组分析。使用倾向评分作为最终模型的预测指标。
分析了 181 例入院病例，92 例在 POU，89 例在住院病房。观察组的平均 LOS 为 24.4 小时（95%置信区间[CI]，21.7-27.1），住院组为 43.2 小时（95%CI，37.8-48.6）（P<0.01）。在 126 例因呼吸道疾病入院的儿童中，观察组的平均 LOS 为 32.3 小时（95%CI，26.0-38.6），住院组为 48.1 小时（95%CI，42.2-54.0）（P<0.01）。生存分析显示，与住院组相比，观察组的出院时间缩短了 1.61 倍（95%CI，1.07-2.42）（P=0.02），与住院组相比，观察组的出院时间缩短了 1.70 倍（95%CI，1.07-2.71）（P=0.03）。在出院后 7 天内，观察组有 2 例（2%）患者和住院组有 1 例（1%）患者返回儿科急诊室。
这些发现表明，POU 可为在社区环境中需要短暂住院的疾病患儿提供高效护理手段。需要进一步的前瞻性研究来确定这些发现的普遍性。
