Presented at the Pediatric Academic Societies Annual Meeting, Vancouver, BC, Canada, May 2010; and the American Public Health Association Annual Meeting & Exposition, Denver, CO, November 2010.
Resource Burden at Children’s Hospitals Experiencing Surge Volumes During the Spring 2009 H1N1 Influenza Pandemic
Article first published online: 11 FEB 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 2, pages 158–166, February 2011
How to Cite
Sills, M. R., Hall, M., Simon, H. K., Fieldston, E. S., Walter, N., Levin, J. E., Brogan, T. V., Hain, P. D., Goodman, D. M., Fritch-Levens, D.D., Fagbuyi, D. B., Mundorff, M. B., Libby, A. M., Anderson, H. O., Padula, W. V. and Shah, S. S. (2011), Resource Burden at Children’s Hospitals Experiencing Surge Volumes During the Spring 2009 H1N1 Influenza Pandemic. Academic Emergency Medicine, 18: 158–166. doi: 10.1111/j.1553-2712.2010.00992.x
Disclosures: MRS was funded by AHRQ 5R03HS016418. SSS received salary and other support (NIH K01 AI73729) in the context of a Career Development Award. The Robert Wood Johnson foundation under its Physician Faculty Scholar Program provides support to SSS in the context of a Career Development Award. The Robert Wood Johnson Foundation, under its Physician Faculty Scholar Program, provides SSS funds to travel to scientific meetings. SSS completed research support (September 2009) at Wyeth Pharmaceuticals to study the pharmacokinetics of the antibiotic tigecycline. SSS received research support from Child Health Corporation of America as an executive council member of the Pediatric Research in Inpatient Settings Network to identify research priorities in the field of Pediatric Hospital Medicine by identifying high-cost, high-volume, and high-variability conditions (active support). SSS received royalties for textbook editorship from McGraw-Hill Medical, Lippincott Williams & Wilkins, and Elsevier Saunders. None declared: NW, WVP, HOA, AML, ESF, TVB, DDFL, DBF, MBM, Hatfield, HKS, DMG, PDH, MH.
The content of the manuscript is solely the responsibility of the authors and does not necessarily represent the views of the NIH.
Supervising Editor: Gregory Conners, MD.
- Issue published online: 11 FEB 2011
- Article first published online: 11 FEB 2011
ACADEMIC EMERGENCY MEDICINE 2011; 18:158–166 © 2011 by the Society for Academic Emergency Medicine
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.