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Utilization of Monitored Beds for Children Admitted With Unintentional Poisonings
Cassi Smola1, Chang L Wu1, Sridaran Narayanan2
1From the Division of Pediatric Hospital Medicine, University of Alabama at Birmingham, Birmingham, AL.
Insights
Most children admitted for unintentional poisonings (UPs) go to monitored beds (MBs), but few need intensive care. This suggests that current admission practices for pediatric UPs may be overutilizing resources, as no adverse events occurred in this study.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Toxicology
- Hospital Resource Utilization
Background:
- Unintentional poisonings (UPs) in children often lead to admission to monitored beds (MBs).
- However, most pediatric UP cases require minimal medical intervention.
- This highlights a potential for optimizing resource allocation in pediatric care.
Purpose of the Study:
- To describe clinical factors and outcomes for children admitted for UPs.
- To identify clinical factors associated with MB placement in pediatric UP cases.
- To evaluate the necessity of MB admissions for pediatric unintentional poisonings.
Main Methods:
- Retrospective cohort study of children under 6 years admitted for UPs.
- Analysis of disposition (MB vs. non-MB) as the primary outcome.
- Multivariable logistic regression used to identify factors associated with MB placement.
Main Results:
- 89% of pediatric UP patients were admitted to MBs.
- Factors increasing MB admission included certainty of ingestion, altered mental status, and care by a fellow.
- No inpatient escalations, readmissions, or deaths were observed across all admitted patients.
Conclusions:
- The majority of pediatric unintentional poisoning admissions are to MBs.
- No adverse events occurred, indicating potential overutilization of monitored beds.
- Further research on costs and interventions could refine admission guidelines for pediatric UPs.
Objectives:
Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement.
Methods:
In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression.
Results:
Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52-11.58), altered mental status (aOR, 5.82; 95% CI, 2.45-13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04-5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93-23.59).
Conclusions:
The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings.
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