Could Hsp be an Adverse Event Following Immunization? A Report From the Canadian Pediatric Society Immunization Monitoring Program, Active (Impact)

Abstract

a standardized protocol implemented in 2005. We assumed children with the following criteria could have been sent home with O 2 , instead of being kept in hospital: age = or >2 months, distance between home and hospital <50 km, in-hospital observation = or >48 hr, need for iv fluids <50 mL/kg/day, no gavage feeding, O2 requirement = or > 0.5 L/min and stable clinical condition over the last 24 hrs. Children with significant underlying disease were excluded. results: One hundred seventy-seven infants were included in the study. Median age was 2.0 months (range 0-11); 54.8% were male. Eighty eight per cent (156/177) were admitted for a first episode of bronchiolitis, and 75.3% of those tested were RSV positive (116/154). Median length of stay was 3.0 days (range 0-18). Admission to PICU and mechanical ventilation were required for 14.7% and 13.6% of patients, respectively. Forty five percent of patients (79/177) received oxygen during their hospital stay. Of these 79 children, 49.4% were = or >2 months of age, 72.2% lived within 50 km of the hospital and 91.1% were hospitalized 48 hr or more. Criteria for early discharge with HOT were met in only 9 children (5.1% of all patients), a mean of 1.1 days (SD 0.8) prior to discharge. For the entire cohort, the number of patient-days of hospitalization which would have been saved with HOT was 10, representing 1.4% of total patient-days of hospitalization for bronchiolitis in otherwise well children over the study period (10/703). conclusions: In our setting, HOT would be minimally effective in reducing length of stay of infants hospitalized for bronchiolitis. . We found differences in patient volumes, workload, distance walked and supervision between the 3 periods (medians reported): of assigned patients (23.5, 27, 22, p=0.002), overnight admissions (4, 3, 2, p<0.0001), pages (27.5, 24, 15.5, p<0.0001), minutes entering orders (70, 105, 65, p=0.003), minutes examining patients (75, 120, 90, p=0.0004), minutes communicating with patients and families (100, 140, 120, p=0.004) and minutes communicating with the staff physician (not measured, 87.5, 30, p<0.0001). Patient emergencies were reported in 9 (15%), 46 (83%) and 15 (24%) shifts (p<0.0001). Trainees reported learning at any stage during 54 (89%), 39 (71%) and 48 (76%) shifts, and specifically overnight during 46 (75%), 14 (25%), 20 (32%) shifts (p<0.0001). conclusions: We performed a before and after evaluation of the effect of duty hour reductions in a paediatric teaching hospital using prospective self-report. We found significant differences in workload and supervision between periods. The overall proportions of shifts where trainees reported learning was similar, although perceived learning during the night portion of the shift reduced significantly from 2005 to 2009. The inclusion of a remote control group provides additional context in which to frame the shorter term comparisons before and after implementation of the July 2009 duty hour regulations. sHoUld tHis HosPitaliZed cHild receiVe eMPiric treatMeNt WitH ...