Treating measles: the appropriateness of admission to a Wisconsin Children's Hospital

Objectives. A large number of children with measles were hospitalized at a children's hospital during a metropolitan measles outbreak. In this study we addressed the appropriateness of those admissions. Methods. Charts of all 634 patients with a diagnosis of measles who were treated between August 1989 and April 1990 were reviewed. Determination of the appropriateness of hospital admission was based on severity of illness and presence of severe of complications of measles. Results. Of 564 patients with clinical measles or serologic evidence of recent infection, 252 were inpatients (median age 1.5 years) and 312 were outpatients (median age 2.1 years). Fifty-nine (23.4%) of the inpatients had been inappropriately admitted. Inpatients were significantly more likely than outpatients to have physiologic instability or a clinical complication. Chidren 15 months of age or younger were more likely to be hospitalized, as were children evaluate in the first 3 months of the outbreak period, even if admission was not appropriate on the basis of physiological instability or complications. Conclusions. Younger patients with measles and patients evaluated earlier in the epidemic were more likely to be admitted to the hospital even when admission was inappropriate as assessed by degree of physiologic instability or presence of complications. (Am J Public Health. 1993;83:379-384)
Younger children or those who develop measles earlier in a measles outbreak may more likely to be admitted inappropriately to the hospital for treatment than other measles patients. Among 564 children suffering from measles who were treated at Children's Hospital of Wisconsin between Apr 1989 and Apr 1990, 312 were treated as outpatients and 252 were treated as inpatients. While most admissions were appropriate, 59 children treated as inpatients were admitted to the hospital inappropriately. Children under 15 months old were more likely to be admitted to the hospital for treatment than older children, regardless of severity of illness. Patients who were treated during the first three months of the measles outbreak were also more likely to be admitted to the hospital than those treated later, reflecting doctors' initial unfamiliarity with diagnosing and treating measles. Children treated as inpatients were more likely to be physiologically unstable or have some type of complication.