Resource Burden at Children’s Hospitals Experiencing Surge Volumes During the Spring 2009 H1N1 Influenza Pandemic

Authors

  • Marion R. Sills MD, MPH,

    1. 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.
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  • Matthew Hall PhD,

    1. 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.
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  • Harold K. Simon MD, MBA,

    1. 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.
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  • Evan S. Fieldston MD, MBA, MSHP,

    1. 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.
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  • Nicholas Walter MD, MS,

    1. 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.
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  • James E. Levin MD, PhD,

    1. 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.
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  • Thomas V. Brogan MD,

    1. 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.
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  • Paul D. Hain MD,

    1. 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.
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  • Denise M. Goodman MD, MS,

    1. 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.
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  • D.D. Fritch-Levens RN, BSN,

    1. 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.
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  • Daniel B. Fagbuyi MD,

    1. 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.
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  • Michael B. Mundorff MBA, MHSA,

    1. 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.
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  • Anne M. Libby PhD,

    1. 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.
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  • Heather O. Anderson PhD,

    1. 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.
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  • William V. Padula MS,

    1. 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.
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  • Samir S. Shah MD, MSCE

    1. 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.
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  • 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.

  • 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.

Address for correspondence and reprints: Marion R. Sills, MD, MPH; e-mail: sills.marion@tchden.org.

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.

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