[Short-stay observation in the Pediatric Emergency Room: a 2003-1993 comparison]

To evaluate the effectiveness of Short-Stay Observation (SSO) in the paediatric Emergency Room (ER) according to changes over time of guidelines.

This retrospective study analyses the probability of discharge immediately from ER or after SSO and of hospital admission in Trieste during 2003 as compared with 1993. Subjects aged under 18 with respiratory, urinary tract, neurological and gastrointestinal pathologies, selected symptoms and injuries were studied.

In 2003 the 86.2% of 6 350 patients enrolled in the study were discharged immediately, compared with the 81.7% of 5475 subjects in 1993 (RR 1.05, IC 95% 1.04-1.07), the 10.0% were discharged after SSO, compared with the 5.9% in 1993 (RR 1.71, IC 95% 1.50-1.95). The 3.8% of the subjects were admitted in 2003, compared to the 12.4% in 1993 (RR 0.30, IC 95% 0.26-0.35). The role of SSO was particularly significant in case of pneumonia, URI, urinary tract infections, seizures, gastroenteritis, abdominal pain, infant fever, injuries.

The decrease of hospital admissions, pointed out in 2003, are related to a better choice of candidates for SSO and to changes in guidelines concerning the approach to urinary tract infections and seizures, the treatment of respiratory distress and gastroenteritis dehydration, and the early identification of predictors of injuries complications. The study confirms the effectiveness of SSO in both avoiding inappropriate admissions and reducing those with limited needs of hospital assistance, assuring the quality of care. The reduced hospital stay decreases child and his family discomfort and favours the care continuity due to the involvement of family paediatrician.