• Florence T Bourgeois, Michael C Monuteaux, Anne M Stack, and Mark I Neuman.
• Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; andDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts florence.bourgeois@childrens.harvard.edu.
• Pediatrics. 2014 Sep 1;134(3):539-45.

ObjectiveTo measure the hospital-level variation in admission rates for children receiving treatment of common pediatric illnesses across emergency departments (EDs) in US children's hospitals.MethodsWe performed a multi-center cross sectional study of children presenting to the EDs of 35 pediatric tertiary-care hospitals participating in the Pediatric Health Information System (PHIS). Admission rates were calculated for visits occurring between January 1, 2009, and December 31, 2012, associated with 1 of 7 common conditions, and corrected to adjust for hospital-level severity of illness. Conditions were selected systematically based on frequency of visits and admission rates.ResultsA total of 1288706 ED encounters (13.8% of all encounters) were associated with 1 of the 7 conditions of interest. After adjusting for hospital-level severity, the greatest variation in admission rates was observed for concussion (range 5%-72%), followed by pneumonia (19%-69%), and bronchiolitis (19%-65%). The least variation was found among patients presenting with seizures (7%-37%) and kidney and urinary tract infections (6%-37%). Although variability existed in disease-specific admission rates, certain hospitals had consistently higher, and others consistently lower, admission rates.ConclusionsWe observed greater than threefold variation in severity-adjusted admission rates for common pediatric conditions across US children's hospitals. Although local practices and hospital-level factors may partly explain this variation, our findings highlight the need for greater focus on the standardization of decisions regarding admission.Copyright © 2014 by the American Academy of Pediatrics.

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