Prevalence and predictors of return visits to pediatric emergency departments

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Epidemiology

Background:

• Pediatric emergency departments (EDs) manage a significant volume of patient visits.
• Understanding return visit patterns is crucial for optimizing healthcare resource allocation and patient care.
• Identifying factors associated with revisits can inform targeted interventions.

Purpose of the Study:

• To determine the rate of return visits to pediatric EDs within 72 hours of discharge.
• To identify patient- and visit-level factors associated with these return visits.
• To identify factors associated with hospitalization upon return to the ED.

Main Methods:

• Retrospective cohort study utilizing data from the Pediatric Health Information System (PHIS) in 2012.
• Included patients under 18 years old discharged from 23 pediatric EDs.
• Primary outcomes were return visits within 72 hours and hospitalizations during these return visits.

Main Results:

• 3.3% of discharged pediatric ED patients (47,294/1,415,721) had a return visit within 72 hours.
• Of those returning, 19.7% (9,295) were hospitalized.
• Factors associated with increased return visits included chronic conditions, higher severity scores, and age under 1 year. Higher severity, chronic conditions, younger age, overnight arrival, and private insurance were associated with hospitalization on return.

Conclusions:

• Patient and visit characteristics significantly influence the likelihood of pediatric ED revisits and subsequent hospitalizations.
• Specific patient groups, such as those with sickle cell disease (10.7%) and cancer (7.3%), exhibit particularly high revisit rates.
• These findings can guide strategies to optimize care and reduce unnecessary ED utilization.