tetano
Editor, Senior Moderator
Acad Emerg Med. 2011 Feb;18(2):158-166. doi: 10.1111/j.1553-2712.2010.00992.x.
Resource Burden at Children's Hospitals Experiencing Surge Volumes During the Spring 2009 H1N1 Influenza Pandemic.
Sills MR, Hall M, Simon HK, Fieldston ES, Walter N, Levin JE, Brogan TV, Hain PD, Goodman DM, Fritch-Levens DD, Fagbuyi DB, Mundorff MB, Libby AM, Anderson HO, Padula WV, Shah SS.
From the Department of Pediatrics, University of Colorado School of Medicine, and the Section of Emergency Medicine, Children's Hospital (MRS), Aurora, CO; the Child Health Corporation of America (MH), Shawnee Mission, KS; the Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Health Care of Atlanta (HKS), Atlanta, GA; the Department of Pediatrics, University of Pennsylvania School of Medicine, and the Division of General Pediatrics, Children's Hospital of Philadelphia (ESF), Philadelphia, PA; the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine (NW), Aurora, CO; The Children's Hospital of Pittsburgh of UPMC (JEL), Pittsburgh, PA; the Division of Critical Care Medicine, Seattle Children's Hospital, and the Department of Pediatrics, University of Washington School of Medicine (TVB), Seattle, WA; the Monroe Carell Jr. Children's Hospital at Vanderbilt (PDH), Nashville, TN; the Division of Critical Care Medicine, Children's Memorial Hospital, and the Department of Pediatrics, Northwestern University (DMG), Chicago, IL; Emergency Services, Children's Health care of Atlanta (DDF), Atlanta, GA; the Department of Pediatrics, The George Washington University School of Medicine, and the Division of Emergency Medicine, Children's National Medical Center (DBF), Washington, DC; the System Improvement Department, Primary Children's Medical Center (MBM), Salt Lake City, UT; the University of Colorado School of Pharmacy (AML), Aurora, CO; the Department of Epidemiology, Colorado School of Public Health (HOA), Aurora, CO; the Pharmaceutical Outcomes Research Program, University of Colorado at Denver and Health Sciences Center (WVP), Aurora, CO; and the Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Division of Infectious Diseases, The Children's Hospital of Philadelphia (SSS), Philadelphia, PA.
Abstract
ACADEMIC EMERGENCY MEDICINE 2011; 18:158-166 ? 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives: The objective was to describe the emergency department (ED) resource burden of the spring 2009 H1N1 influenza pandemic at U.S. children's hospitals by quantifying observed-to-expected utilization. Methods: The authors performed an ecologic analysis for April through July 2009 using data from 23 EDs in the Pediatric Health Information System (PHIS), an administrative database of widely distributed U.S. children's hospitals. All ED visits during the study period were included, and data from the 5 prior years were used for establishing expected values. Primary outcome measures included observed-to-expected ratios for ED visits for all reasons and for influenza-related illness (IRI). Results: Overall, 390,983 visits, and 88,885 visits for IRI, were included for Calendar Weeks 16 through 29, when 2009 H1N1 influenza was circulating. The subset of 106,330 visits and 31,703 IRI visits made to the 14 hospitals experiencing the authors' definition of ED surge during Weeks 16 to 29 was also studied. During surge weeks, the 14 EDs experienced 29% more total visits and 51% more IRI visits than expected (p < 0.01 for both comparisons). Of ED IRI visits during surge weeks, only 4.8% were admitted to non-intensive care beds (70% of expected, p < 0.01), 0.19% were admitted to intensive care units (44% of expected, p < 0.01), and 0.01% received mechanical ventilation (5.0% of expected, p < 0.01). Factors associated with more-than-expected visits included ages 2-17 years, payer type, and asthma. No factors were associated with more-than-expected hospitalizations from the ED. Conclusions: During the spring 2009 H1N1 influenza pandemic, pediatric EDs nationwide experienced a marked increase in visits, with far fewer than expected requiring nonintensive or intensive care hospitalization. The data in this study can be used for future pandemic planning.
? 2011 by the Society for Academic Emergency Medicine.
PMID: 21314775 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21314775
Resource Burden at Children's Hospitals Experiencing Surge Volumes During the Spring 2009 H1N1 Influenza Pandemic.
Sills MR, Hall M, Simon HK, Fieldston ES, Walter N, Levin JE, Brogan TV, Hain PD, Goodman DM, Fritch-Levens DD, Fagbuyi DB, Mundorff MB, Libby AM, Anderson HO, Padula WV, Shah SS.
From the Department of Pediatrics, University of Colorado School of Medicine, and the Section of Emergency Medicine, Children's Hospital (MRS), Aurora, CO; the Child Health Corporation of America (MH), Shawnee Mission, KS; the Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children's Health Care of Atlanta (HKS), Atlanta, GA; the Department of Pediatrics, University of Pennsylvania School of Medicine, and the Division of General Pediatrics, Children's Hospital of Philadelphia (ESF), Philadelphia, PA; the Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine (NW), Aurora, CO; The Children's Hospital of Pittsburgh of UPMC (JEL), Pittsburgh, PA; the Division of Critical Care Medicine, Seattle Children's Hospital, and the Department of Pediatrics, University of Washington School of Medicine (TVB), Seattle, WA; the Monroe Carell Jr. Children's Hospital at Vanderbilt (PDH), Nashville, TN; the Division of Critical Care Medicine, Children's Memorial Hospital, and the Department of Pediatrics, Northwestern University (DMG), Chicago, IL; Emergency Services, Children's Health care of Atlanta (DDF), Atlanta, GA; the Department of Pediatrics, The George Washington University School of Medicine, and the Division of Emergency Medicine, Children's National Medical Center (DBF), Washington, DC; the System Improvement Department, Primary Children's Medical Center (MBM), Salt Lake City, UT; the University of Colorado School of Pharmacy (AML), Aurora, CO; the Department of Epidemiology, Colorado School of Public Health (HOA), Aurora, CO; the Pharmaceutical Outcomes Research Program, University of Colorado at Denver and Health Sciences Center (WVP), Aurora, CO; and the Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Division of Infectious Diseases, The Children's Hospital of Philadelphia (SSS), Philadelphia, PA.
Abstract
ACADEMIC EMERGENCY MEDICINE 2011; 18:158-166 ? 2011 by the Society for Academic Emergency Medicine ABSTRACT: Objectives: The objective was to describe the emergency department (ED) resource burden of the spring 2009 H1N1 influenza pandemic at U.S. children's hospitals by quantifying observed-to-expected utilization. Methods: The authors performed an ecologic analysis for April through July 2009 using data from 23 EDs in the Pediatric Health Information System (PHIS), an administrative database of widely distributed U.S. children's hospitals. All ED visits during the study period were included, and data from the 5 prior years were used for establishing expected values. Primary outcome measures included observed-to-expected ratios for ED visits for all reasons and for influenza-related illness (IRI). Results: Overall, 390,983 visits, and 88,885 visits for IRI, were included for Calendar Weeks 16 through 29, when 2009 H1N1 influenza was circulating. The subset of 106,330 visits and 31,703 IRI visits made to the 14 hospitals experiencing the authors' definition of ED surge during Weeks 16 to 29 was also studied. During surge weeks, the 14 EDs experienced 29% more total visits and 51% more IRI visits than expected (p < 0.01 for both comparisons). Of ED IRI visits during surge weeks, only 4.8% were admitted to non-intensive care beds (70% of expected, p < 0.01), 0.19% were admitted to intensive care units (44% of expected, p < 0.01), and 0.01% received mechanical ventilation (5.0% of expected, p < 0.01). Factors associated with more-than-expected visits included ages 2-17 years, payer type, and asthma. No factors were associated with more-than-expected hospitalizations from the ED. Conclusions: During the spring 2009 H1N1 influenza pandemic, pediatric EDs nationwide experienced a marked increase in visits, with far fewer than expected requiring nonintensive or intensive care hospitalization. The data in this study can be used for future pandemic planning.
? 2011 by the Society for Academic Emergency Medicine.
PMID: 21314775 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/21314775