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Epidemiology of the Critically Ill Child in the Resuscitation Bay

Chavez, Hector, MD*; Garcia, Carmen, Teresa, MD; Sakers, Cathy, MSN, ARNP; Darko, Richmond, MD, MPH§; Hannan, Jean, PhD, ARNP

doi: 10.1097/PEC.0000000000000682
Original Articles

Background Children account for approximately 33 million annual emergency department (ED) visits in the United States. The spectrum and frequency of children with a critical illness presenting to an ED has not been previously analyzed.

Objective The purpose of this study was to examine the range of critical illness presenting to a tertiary Children's Hospital ED.

Methods This study was a retrospective chart review of all pediatric patients requiring immediate care in the medical resuscitation bay during a 25-month period from August 2005 to September 2007. Data are from a single center, academic, tertiary care pediatric hospital. A log of all patients requiring immediate care is kept in the medical resuscitation bay. Patients recorded in the log for a period of 25 consecutive months were reviewed for type of critical illness, frequency of critical illness, mode of arrival, and outcome. Trauma patients were excluded.

Results There were approximately 45,000 pediatric visits per year with a total of 87,766 patients seen during the study period. There were 249 pediatric patients who required care in the medical resuscitation bay during the reviewed period. Complete data were obtained from 242 subjects' charts. Patients requiring immediate care accounted for 0.28% of all the visits.

Conclusions This study documents the infrequent need for pediatric critical care in the ED of a nonacademic tertiary children's hospital in the United States and reinforces the need to provide protocols, mock codes, and simulation labs in preparation for critically ill children.

From the *Pediatric Emergency Department, Holtz Children's Hospital at Jackson Memorial Hospital, Joe DiMaggio Children's Hospital, Hollywood; †Pediatric Emergency Department, Holtz Children's Hospital at Jackson Memorial Hospital, Miami; ‡Joe DiMaggio Children's Hospital Pediatric Emergency Department, Hollywood; §University of Miami School of Medicine, Holtz Children's Hospital at Jackson Memorial Hospital; and ∥College of Nursing and Health Sciences, Florida International University, Miami, FL.

Disclosure: The authors declare no conflict of interest.

Reprints: Hector Chavez, MD, Emergency Department, Jackson Memorial Hospital-Holtz Children's, 1611 NW 12th Ave, Miami, FL 33136 (e-mail:

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