title: Utilization of a pediatric observation unit for toxicologic ingestions.
abstract: OBJECTIVE
  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.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. jenplumb@yahoo.com
authors.forename: Jennifer
authors.initials: J
authors.lastname: Plumb
authors.forename: Nanette C
authors.initials: NC
authors.lastname: Dudley
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Herman
authors.forename: Howard A
authors.initials: HA
authors.lastname: Kadish
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004435:Eating; D005260:Female; D015386:Hazardous Substances / Q000633:toxicity*; D006757:Hospital Units / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D019370:Observation; D011041:Poisoning / Q000175:diagnosis*; D012189:Retrospective Studies
chemical_list: D015386:Hazardous Substances