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Predictor Factors for Emergency Department revisiting of children with acute gastroenteritis: Case-control study
Arístides Rivas García1, Sara Vigil Vázquez1, Sara Bragado López1
1Sección de Urgencias Pediátricas, Hospital Universitario Gregorio Marañón, Madrid, España.
Insights
Younger children with acute gastroenteritis and increased stool output are more likely to return to the Emergency Department (ED). Rotavirus vaccination may reduce these revisits, but treatments during the first visit did not.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- Acute gastroenteritis is a common reason for pediatric Emergency Department (ED) visits.
- Understanding risk factors for reconsultation is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To identify risk factors for reconsultation in pediatric patients diagnosed with acute gastroenteritis during their initial Emergency Department (ED) visit.
Main Methods:
- A case-control study was conducted involving pediatric patients (0-16 years) over four years.
- Cases were defined as gastroenteritis episodes with reconsultation within 72 hours; controls were matched patients who did not reconsult.
- Logistic regression models were used to analyze epidemiological, clinical, and intervention-related variables.
Main Results:
- Gastroenteritis constituted 5.3% of ED visits, with 6.2% of patients reconsulting within 72 hours.
- Key risk factors for reconsultation included younger age, absence of rotavirus vaccination, no prior primary care assessment, increased stool output, and stool collection during the ED visit.
- Multivariate analysis indicated an association between reconsultation and these factors.
Conclusions:
- Younger children with higher stool output are at increased risk of ED reconsultation for gastroenteritis.
- Rotavirus vaccination shows potential in reducing reconsultation rates.
- Current diagnostic and therapeutic interventions during the initial ED visit did not appear to decrease the likelihood of reconsultation.
Introduction:
The objective of this work is to describe risk factors for reconsultation in patients with an acute gastroenteritis diagnosis, identifiable in their first visit to the Emergency Department.
Patients And Method:
Case-control study, including patients aged between 0-16 years who consulted in the Emer gency Department (ED) of a tertiary hospital for 4 years. The case is defined as the episode with a gastroenteritis diagnosis that reconsulted within 72 hours. A control was selected for each case, which was the first patient to consult after each case with the same diagnosis and not reconsulted later. Epidemiological and clinical variables, and diagnostic-therapeutic interventions carried out during the first visit were studied. Univariate and multivariate analyses of the reconsultation risk were per formed using logistic regression models.
Results:
Gastroenteritis diagnoses accounted for 5.3% of all ED visits. 745 patients (6.2%) reconsulted within 72 hours. Multivariate analysis found association between reconsultation with each year of increasing age (OR 0.94, 95% CI 0.91-0.97), absence of rotavirus vaccination (OR 1.47, 95% CI: 1.11-1.95), no prior assessment in primary care (OR 1.55, 95% CI 1.09-2.19), increased stool output in the last 24 hours (OR 1.06, 95% CI 1.02-1.10), and stool collection in the ED (OR 1.54, 95% CI 1.05-2.24).
Conclusions:
Younger patients with an increased stool output are especially susceptible to return to the ED for consultation. Rotavirus vaccination could reduce reconsultation. None of the diagnostic-therapeutic actions carried out seems to reduce the number of visits to the ED.
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