RESUMEN
OBJECTIVES: The aim of the study was to assess the impact of an observation unit (OU) on hospital resource utilization for patients with croup. METHODS: A retrospective review with the use of a historical control was performed for 2 years of nondischargeable emergency department (ED) patients with croup. RESULTS: The total number of ED patients with croup was 694 in the first year and 789 in the second year. Hundred seventy patients were enrolled, 66 in the first year and 104 in the second year (76 admitted to the OU and 33 admitted to the ward). There was a reduction in the ward admission rate from 9.5% to 4.2% (P < .0001) from the first to the second year. The median length of stay for the pre-OU group was 27.2 vs 21.3 hours for the post-OU group (P = .03). The median charge for the pre-OU group was $1685 vs $1327 for the post-OU group (P = .03). CONCLUSIONS: After the introduction of the OU, hospitalization was reduced, and the overall resource utilization for the care of nondischargeable ED patients with croup was reduced.
Asunto(s)
Crup/terapia , Servicio de Urgencia en Hospital/organización & administración , Precios de Hospital , Unidades Hospitalarias/organización & administración , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Niño , Preescolar , Servicio de Urgencia en Hospital/economía , Femenino , Unidades Hospitalarias/economía , Humanos , Lactante , Tiempo de Internación/economía , Masculino , Admisión del Paciente/economía , Evaluación de Programas y Proyectos de Salud , Estudios RetrospectivosRESUMEN
BACKGROUND: Intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) has reduced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare. OBJECTIVE: To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms. METHODS: The results of bacterial cultures from infants 1 to 90 days old evaluated for fever at Primary Children's Medical Center in Salt Lake City, Utah, between July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organism. RESULTS: Of 1298 febrile infants enrolled from the Primary Children's Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2-82 days) and 2 (2%) were <7 days. SBI included urinary tract infection (UTI; 67%), bacteremia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningitis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most common pathogen was Escherichia coli (61%). Other Gram-negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-positive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI. Of the 105 pathogens, 56 (53%) were resistant to ampicillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resistant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism. CONCLUSIONS: In Utah, ampicillin-resistant Gram-negative bacteria are the most common cause of SBI in febrile infants <90 days old. This finding impacts antibiotic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic therapy.
Asunto(s)
Resistencia a la Ampicilina , Infecciones Bacterianas/prevención & control , Estado de Salud , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Cefotaxima/metabolismo , Cefotaxima/uso terapéutico , Farmacorresistencia Bacteriana , Fiebre/tratamiento farmacológico , Fiebre/epidemiología , Fiebre/microbiología , Gastroenteritis/tratamiento farmacológico , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Gentamicinas/metabolismo , Gentamicinas/uso terapéutico , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/epidemiología , Directrices para la Planificación en Salud , Humanos , Lactante , Recién Nacido , Meningitis/tratamiento farmacológico , Meningitis/epidemiología , Meningitis/microbiología , Pruebas de Sensibilidad Microbiana/métodos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiologíaRESUMEN
Cases of pediatric nonenvironmental hypothermia are uncommon. When presenting to the emergency department, these patients are often evaluated for possible sepsis/shock, brain tumors, endocrine disorders, and drug ingestions. We report a case of a 5-year-old girl who presented to the pediatric emergency department on two occasions with hypothermia and lethargy. She was found to have an unusual cause of her symptoms: episodic spontaneous hypothermia with hyperhidrosis.