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Updated: Oct 26, 2025

Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
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Trends and Variation in the Use of Observation Stays at Children's Hospitals

Yao Tian1, Matt Hall2, Martha-Conley E Ingram1,3

  • 1Surgical Outcomes Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Journal of Hospital Medicine
|July 30, 2021
PubMed

Insights

Pediatric observation stays increased significantly from 2010 to 2019, with prolonged stays also rising. This trend highlights the need to study healthcare resource use and financial impacts of observation care in children.

Area of Science:

  • Pediatric healthcare utilization
  • Health services research
  • Hospital administration

Background:

  • Observation status in healthcare can enhance resource efficiency but may shift costs to patients and hospitals.
  • While observation stays have risen in adults, trends in pediatric populations are not well-documented.

Purpose of the Study:

  • To analyze recent trends in the utilization of observation stays for pediatric patients in children's hospitals.
  • To identify changes in the frequency and duration of pediatric observation care over a decade.

Main Methods:

  • Retrospective analysis of the Pediatric Health Information System database from 2010 to 2019.
  • Categorization of patient stays into inpatient or observation status.
  • Calculation of annual percentages of observation stays, prolonged observation stays (>2 days), and growth rates for common conditions, using risk-adjusted generalized linear mixed-effects models.

Main Results:

  • The proportion of observation stays among all pediatric hospitalizations increased from 23.6% in 2010 to 34.3% in 2019 (P < .001).
  • The percentage of observation stays with prolonged length of stay (>2 days) rose from 1.1% to 4.6% (P < .001).
  • Observation status expanded across various conditions, with notable growth in diabetes mellitus and surgical procedures; hospital-level use varied significantly (0% to 67% in 2019).

Conclusions:

  • The increasing trend in pediatric observation stays warrants further investigation into the appropriateness of this care model.
  • Future research should address the efficient use of healthcare resources and the financial implications of observation care for both hospitals and patients.
Abstract

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