Table 1.
General Description of US Pediatric Observation Units
| Publication | Study design - Level of evidence | Hospital | Site | Beds | Entry point | Staffing |
|---|---|---|---|---|---|---|
| Condition | Time frame Sample size |
Observation setting Year opened |
Physicians Nurses |
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| Gururaj 1972 | Retrospective cohort - 2c | King's County Downstate Brooklyn | ED | 3 | Not reported | Pediatric residents General pediatricians |
| All conditions | 1 year 437 cases under observation |
Short Stay Unit | ||||
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| Ellerstein 1980 | Retrospective cohort - 2c | Children's Hospital Buffalo | ED | 8 | ED Clinic Procedure/OR |
Primary care pediatricians Other specialists Pediatric residents |
| All conditions | 6 years 5,858 cases of unscheduled care plus 1,403 elective surgery cases |
Observation Unit 1972 |
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| O'Brien 1980 | Retrospective cohort - 2c | Children's National DC | ED | 6 | ED | 1–2 Pediatric residents |
| Asthma | 1 month 434 cases of asthma 328 discharged directly from ED 106 treated in holding unit |
Holding Unit | 1–2 Nurses | |||
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| Willert 1985 | Randomized* - 2b | Children's Memorial Chicago | ED | 5 | ED | General pediatricians Pediatric residents |
| Asthma | 578 cases of asthma 166 cases 1.5 hrs post-aminophylline 103 randomized, 52 to holding unit *Limited by bed availability, patient preference. |
Holding Room | ||||
| Listernick 1986 | Randomized* - 2b | PEM nurses | ||||
| Dehydration | 29 cases of dehydration 22 to holding unit *IV hydration, admission per parent preference. |
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| Balik 1988 | Descriptive | Minneapolis Children's | Day surgery area adjacent to ED | Not reported | Not reported | General pediatricians |
| All conditions | None given | Short Stay Unit Observation Area 1985 |
Pediatric nurses (shared w/ ED) |
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| Marks 1997 | Retrospective cohort - 2c | Children's Hospital Boston | Ward | 4–18 | ED | Primary care pediatricians PEM physicians Pediatric residents |
| All conditions | 5 months 968 cases in short stay unit |
Short Stay Unit 1994 |
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| Asthma | Pre-post - 2b | Pediatric nurses 1:6 nurse:patient ratio |
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| 400 cases of asthma 102 pre/ 298 post short stay unit |
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| Wiley 1998 | Retrospective cohort - 2c | Connecticut Children's | ED | 10 | Not reported | PEM physicians Other specialists |
| All conditions | 1 year 805 cases of unscheduled observation plus 595 scheduled cases |
Outpatient Extended Treatment Site | ||||
| Scribano 2001 | Retrospective cohort - 2b | 1:5 nurse:patient ratio | ||||
| All conditions | 2 years 1,798 cases under observation |
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| Leduc 2002 | Retrospective cohort - 2c | Children's Hospital Denver | ED | 6 | Not reported | Not reported |
| All conditions | 6 months 686 cases under observation (4.8% of ED visits) |
Observation Unit | ||||
| Bajaj 2003 | Retrospective cohort - 2b | |||||
| Intussusception | 4.5 years 78 cases of intussusception (51 under observation) |
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| Wathen 2004 | Convenience sample - 2c | |||||
| Dehydration | 10 months 182 cases of dehydration (48 under observation) |
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| Crocetti 2004 | Retrospective cohort - 2b | John Hopkin's Bayview | Ward | Not reported | 99% ED 1% “other location” |
General pediatricians covering ED and ward |
| All conditions | 2 years 956 cases under observation |
Observation Status Beds 1997 |
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| Silvestri 2005 | Descriptive | Children's Hospital of Philadelphia | ED | 12 | ED | PEM physicians PEM fellows Urgent care pediatricians ED nurse practitioner Inpatient nurses |
| All conditions | None given | Observation Unit 1999 |
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| Alpern 2008 | Prospective cohort - 1b | |||||
| All conditions | 30 months 4,453 cases under observation |
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| Thomas 2000 | Descriptive | Primary Children's Medical Center | ED | 22–26 | ED Clinic Procedure/OR |
PEM physicians General pediatricians Other specialists No residents |
| All conditions | None given | Rapid Treatment Unit (RTU) 1999 |
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| Zebrack 2005 | Retrospective cohort - 2b | |||||
| All conditions | 2 years 4,189 cases of unscheduled observation plus 2,288 scheduled cases |
PEM nurses 1:4 nurse:patient ratio |
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| Miescier 2005 | Retrospective cohort - 2b | |||||
| Asthma | 2 years 3,029 asthma visits 384 admitted, 301 observed 161cases met inclusion |
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| Holsti 2005 | Retrospective cohort - 2b | |||||
| Head Injury | 2 years 827 CHI visits 273 admitted, 285 observed 284 cases met inclusion |
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| Green berg 2006 | Retrospective pre-post - 2b | |||||
| Croup | 1 year each 694 croup cases pre-RTU 66 admitted 789 croup cases post-RTU 33 admitted, 76 observed |
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| Mallory 2006 | Retrospective cohort - 2b | |||||
| Dehydration | 1 year 430 dehydration cases under observation |
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