Children admitted to the hospital after returning to the emergency department within 72 hours

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Management
• Clinical Outcomes Research

Background:

• Pediatric emergency department (ED) return visits within 72 hours contribute to overcrowding and increased healthcare costs.
• Identifying characteristics of children requiring admission on re-presentation can inform initial management strategies.

Purpose of the Study:

• To compare the characteristics of pediatric patients who returned to the ED and required hospital admission versus those who were discharged upon return.
• To identify predictors of hospital admission for children presenting for a second ED visit within 72 hours.

Main Methods:

• Retrospective chart review of patients aged 19 years and younger at a tertiary pediatric ED over one year.
• Exclusion of patients who left without being seen or against medical advice.
• Statistical analysis (chi-squared and Student t tests) to compare characteristics and determine return and admission rates.

Main Results:

• 4.4% of eligible children (2115/47,655) returned to the ED within 72 hours, with a 16.7% admission rate for these return visits.
• No significant differences were found in age, sex, home language, or time between visits between admitted and discharged returning children.
• Children discharged upon return had significantly lower acuity compared to those admitted (P < 0.001).

Conclusions:

• Over 4% of pediatric ED visits are repeat visits within 72 hours.
• Progression of illness leading to higher acuity is directly associated with hospital admission on the second ED visit.
• Demographic factors and time from the previous visit do not predict admission for returning pediatric patients.