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Repeated emergency department visits among children admitted with meningitis or septicemia: a population-based study
Samuel Vaillancourt1, Astrid Guttmann2, Qi Li3
1Department of Emergency Medicine and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
Insights
Repeated emergency department (ED) visits are common for children with meningitis or septicemia, but outcomes are similar. Without regionalized systems, EDs cannot learn from these critical events.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Epidemiology
- Health Services Research
Background:
- Early diagnosis of pediatric meningitis and septicemia is crucial but challenging.
- Understanding patterns of emergency department (ED) utilization is key to improving care for critically ill children.
Purpose of the Study:
- To determine the frequency of repeated ED visits in children diagnosed with meningitis or septicemia.
- To identify factors associated with repeated ED visits prior to hospitalization.
Main Methods:
- Retrospective cohort study utilizing health administrative data in Ontario, Canada (2005-2010).
- Included children aged 30 days to 5 years hospitalized with meningitis or septicemia.
- Generalized estimating equations used to analyze risk factors for repeated ED visits.
Main Results:
- 21.9% of children had repeated ED visits before admission.
- Repeated visits were linked to older age, less acute triage scores, and initial visits to community hospitals lacking pediatric consultation.
- Children with repeated visits had similar lengths of stay, critical care use, and mortality rates compared to those admitted on initial visit.
Conclusions:
- Repeated ED visits are frequent in pediatric meningitis and septicemia cases.
- A significant proportion of children with repeated visits sought care at different hospitals, hindering learning and care improvement.
- A regionalized reporting system is needed for EDs to learn from critical pediatric events.
Study Objective:
Early diagnosis of children with meningitis or septicemia remains a significant challenge in emergency medicine. We seek to describe the frequency of repeated emergency department (ED) visits among children admitted with meningitis or septicemia in Ontario, Canada.
Methods:
In this retrospective cohort study, using health administrative data, we included all children aged 30 days to 5 years who were hospitalized with a final diagnosis of meningitis or septicemia in Ontario between 2005 and 2010. ED visits at any hospital in the preceding 5 days were identified as potential repeated ED visits. We used generalized estimating equations to model the association of sex, age, triage score, immunocompromised state, visit timing, type of ED, and annual patient volume on the risk of repeated ED visits.
Results:
Of 521 children, 114 (21.9%) had repeated ED visits before admission. Children admitted on initial visit and those with repeated visits had similar median lengths of stay (13 versus 12 days), critical care use (21.1% versus 16.7%), and mortality (mean 2.9%). One in 3 children repeating visits returned to a different hospital. Repeated visits were associated with older age, a less acute triage score, and initial visit to a community hospital without available pediatric consultation.
Conclusion:
In this cohort, repeated ED visits among children with meningitis or septicemia were common, yet they had health outcomes similar to those of children admitted on initial visit. One in 3 returned to a different ED, making it unlikely that EDs and clinicians can learn from these critical events without a regionalized reporting system.
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