ArticleFrontiers in pediatrics2026
A local operational definition of pediatric emergency department overcrowding: an 8-year retrospective observational cohort study from the OACS+ project.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Emergency department (ED) overcrowding is increasingly observed worldwide and is associated with impaired care quality and patient outcomes. However, no universally accepted definition or measurement method exists. This challenge is particularly relevant in pediatric EDs (PEDs), where crowding is shaped by patient volume, staffing, local care structures, spatial capacity, and temporally fluctuating demand, including infectious surges. Objective: This study aimed to derive a locally applicable operational definition of PED overcrowding reflecting the care structures and demand patterns of the University Hospital Augsburg (UKA) PED and supporting future validation, prediction, and intervention studies. Methods: We conducted an 8-year retrospective cohort study (2017-2024) including 141,008 PED visits by children aged 0-18 years at UKA. Candidate parameters included patients leaving without being seen (LWBS), length of stay (LOS), time to triage, and patient-to-staff ratio (ps-ratio). Descriptive analyses covered 2017-2024, whereas ps-ratio analyses were restricted to 2020-2024, when nursing staffing data were available. Correlation analyses assessed bivariate relationships. ROC analyses derived local ps-ratio thresholds using daily LWBS events, operationalized as ≥1 and ≥2 events/day, as binary internal reference anchors. Time-series models examined temporal trends and lockdown-related shifts. Results: The ps-ratio showed the strongest correlations with LOS ( Conclusions: Locally derived operational definitions may improve interpretation of PED overcrowding by linking patient demand to staffing capacity and local care structures. In the OACS + cohort, the ps-ratio emerged as a staffing-sensitive, clinically interpretable operational marker. The proposed threshold should be considered a locally derived exploratory benchmark requiring external validation before application elsewhere.
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