PEDIATRICS Vol. 57 No. 4 April 1976, pp. 540-543
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When Should a Child Be in the Hospital?

A. Frederick North Jr. M.D.1

1 University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania

With the advent of more active and widespread utilization review activities, spurred federally by Professional Standards Review Organization1 (PSRO) legislation and locally by various types of quality assurance programs, physicians who care for children are increasingly concerned with setting norms, criteria, and standards for judging the necessity for admission to hospital and the duration of hospital care.2 Most of the current approaches to devising utilization standards attempt to identify for each common diagnostic category a standard for length of stay based either on statistical analyses of current hospitalization practices3,4 or upon normative values based on a consensus of expert opinion.3 Criteria for admission may also be derived for each diagnosis.2,5-7 Committees of the American Academy of Pediatrics and of state and local medical and pediatric societies are currently devoting a great deal of effort to formulating admission and length of stay standards for a variety of diagnoses which are associated with hospitalization of children.

The approach to formulating utilization standards using separate diagnostic categories may prove not to be well suited to children. As is shown in Tables I and II, a large number of diagnostic categories must be dealt with, and many of the diagnostic categories are so broad that admission and length of stay standards would be impossible to derive except for much smaller subsets. Table I shows the 25 most common diagnoses of children admitted to approximately 1,200 hospitals which reported data to the Professional Activities Survey (PAS) in 1970.2 The diagnostic categories used in this analysis group several separate ICDA diagnostic codes together.

Submitted on March 20, 1975
Accepted on July 15, 1975




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When Should a Child Be in the Hospital?: A. Frederick North, Jr, MD, Revisited
Pediatrics, January 1, 1998; 101(1): 19 - 24.
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