BACKGROUND: Observation status could improve efficiency of healthcare resource use but also might shift financial burdens to patients and hospitals. Although the use of observation stays has increased for adult patient populations, the trends are unknown among hospitalized children.

OBJECTIVE: The goal of this study was to describe recent trends in observation stays for pediatric populations at children’s hospitals.

DESIGN, SETTING, AND PARTICIPANTS: Both observation and inpatient stays for all conditions were retrospectively studied using the Pediatric Health Information System database (2010 to 2019).

EXPOSURE, MAIN OUTCOMES, AND MEASURES: Patient type was classified as inpatient or observation status. Main outcomes included annual percentage of observation stays, annual percentage of observation stays having prolonged length of stay (>2 days), and growth rates of observation stays for the 20 most common conditions. Risk adjusted hospital-level use of observation stays was estimated using generalized linear mixed-effects models.

RESULTS: The percentage of observation stays increased from 23.6% in 2010 to 34.3% in 2019 (P < .001), and the percentage of observation stays with prolonged length of stay rose from 1.1% to 4.6% (P < .001). Observation status was expanded among a diverse group of clinical conditions; diabetes mellitus and surgical procedures showed the highest growth rates. Adjusted hospital-level use ranged from 0% to 67% in 2019, indicating considerable variation among hospitals.

CONCLUSION: Based on the increase in observation stays, future studies should explore the appropriateness of observation care related to efficient use of healthcare resources and financial implications for hospitals and patients.

背景：观察状态可以提高医疗资源的使用效率，但也可能将经济负担转移给患者和医院。尽管成年患者群体中观察停留的使用有所增加，但住院儿童中的趋势尚不清楚。

目的：本研究的目的是描述儿童医院儿科人群观察时间的最新趋势。

设计、设置和参与者：使用儿科健康信息系统数据库（2010 年至 2019 年）对所有条件下的观察和住院时间进行了回顾性研究。

暴露、主要结果和测量：患者类型分为住院或观察状态。主要结果包括观察停留的年百分比、停留时间延长（> 2 天）的观察停留的年度百分比，以及 20 种最常见疾病的观察停留增长率。使用广义线性混合效应模型估计风险调整后的医院级观察时间使用情况。

结果：留观率从 2010 年的 23.6% 增加到 2019 年的 34.3% ( P < .001)，留观时间延长的百分比从 1.1% 上升到 4.6% ( P < .001)。观察状态在不同的临床条件组中得到了扩展；糖尿病和外科手术的增长率最高。2019 年调整后的医院级使用率介于 0% 至 67% 之间，表明医院之间存在相当大的差异。

结论：基于观察时间的增加，未来的研究应探讨与有效利用医疗资源相关的观察护理的适当性以及对医院和患者的财务影响。