Use of a Pediatric Observation Unit for Treatment of Children With Dehydration Caused by Gastroenteritis

Abstract

Observation units (OUs) have emerged as a cost-saving alternative to traditional ward admission for many pediatric illnesses. Dehydration caused by gastroenteritis is a common reason for admission to a pediatric OU. In this study, we describe characteristics of patients with presumed gastroenteritis admitted to a pediatric OU and seek to identify factors associated with unplanned inpatient admission, defined as the inability to discharge an OU patient within 24 hours. Retrospective cohort chart review with nested case-control study of children admitted to a pediatric OU from August 2000 to July 2001 for treatment of dehydration caused by vomiting or diarrhea from presumed gastroenteritis. Controls were defined as patients in the cohort who were successfully discharged within 24 hours from the OU; cases were defined as those requiring unplanned inpatient admission. Four hundred sixty-seven admissions were reviewed; 430 OU admissions involving 417 patients met criteria for inclusion. Patients' mean age was 1.8 years (median, 1.2 years), and 55% were boys. Patients presented with both diarrhea and vomiting in 77% of cases, and 72% had experienced symptoms for 48 hours before presentation. Nineteen percent of patients had temperatures greater than 38 degrees C; 25% had an anion gap of greater than 14; 37% had serum bicarbonate less than 15 mmol/L, and 10% had serum sodium less than 135 or greater than 145 mmol/L. Unplanned inpatient admission was required in 19% of patients. We found no significant association between specific historical, physical examination, and laboratory characteristics and need for an unplanned inpatient admission. Most patients with dehydration caused by gastroeneritis who need more treatment and observation than can reasonably be offered in an emergency department setting should be considered for OU admission regardless of their historical or laboratory characteristics.