Observation unit experience for pediatric poison exposures

Background: Short-Stay Emergency Department Observation Units (OU) are an alternative to hospitalization, but data on OU care of pediatric poisoning exposures is limited. We report the experience of a pediatric OU with this population. Methods: We retrospectively reviewed the charts of children with poison exposure admitted to a pediatric OU during a 30-month period. Data was collected pertaining to demographics, type of exposure, clinical presentation, and rate of hospitalization, and was compared to nonpoisoned OU patients. Results: Of the 91 pediatric patients with poison exposure, 86 complete charts were available for review (94.5%). Of these patients, 49.5% were female, and 82.4% were <6 years of age (range 1.5 months to 16.6 years). There were a total of 98 toxicants implicated, the most common of which were psychoactive drugs (25%) and cardiovascular agents (19%). At OU admission, 33 of 88 patients (38%) had altered mental status or abnormal vital signs. Only 2 of the 53 remaining patients developed abnor-mal vital signs within the OU. Two patients were hospitalized unexpectedly with respiratory distress due to hydrocarbon and charcoal aspiration pneumonitis, respectively; the unexpected hospitalization rate was 2.2%. Three more planned hospitaliza-tions for endoscopy or psychiatric evaluation led to a total hospitalization rate of 5.4%. This hospitalization rate is significantly lower (RR 0.26, 95% CI 0.11-0.62) than the hospitalization rate from the OU for nonpoisoned patients (20.3%) during that time. Mean OU length of stay for nonadmitted poisoned patients was 14.35 hours. There were no adverse events noted as a result of OU placement. Conclusion: Select poisoned pediatric patients appear suitable for OU management and had less frequent unexpected hospitalization from the OU than other diagnoses.