Related Experiment Video
Updated: Sep 7, 2025
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Pediatric Return Visits to the Emergency Department: The Time to Return Curve
Sriram Ramgopal1, Selina Varma1, Timothy W Victor2
1From the Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
The 72-hour metric for pediatric emergency department (ED) return visits is not evidence-based. A 7-day cutoff is statistically derived as more appropriate for characterizing pediatric ED return visits and hospital admission risk.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Clinical Informatics
Background:
- The 72-hour metric for pediatric emergency department (ED) return visits lacks empirical validation.
- Establishing an evidence-based timeframe for pediatric ED return visits is crucial for accurate performance evaluation.
Purpose of the Study:
- To statistically derive an optimal cutoff time point for characterizing pediatric return visits to the ED.
- To compare hospitalization rates between early and late pediatric ED return visits.
Main Methods:
- Retrospective cohort study of pediatric ED discharges and subsequent return visits within 30 days.
- Utilized cumulative hazard curves and multivariable adaptive regression spline modeling to identify a return visit "hinge point".
- Generalized linear mixed modeling assessed the association between return visit timing and hospital admission.
Main Results:
- Analysis of nearly 2 million index ED discharges revealed 193,605 return visits.
- Statistical modeling identified a significant hinge point at 7 days for pediatric ED return visits.
- Early return visits (≤7 days) demonstrated significantly higher adjusted odds of hospital admission (AOR 1.73) compared to late visits (>7 days).
Conclusions:
- An empirically derived 7-day cutoff is more appropriate for characterizing pediatric ED return visits than the traditional 72-hour metric.
- Pediatric ED return visits within 7 days are associated with a substantially higher likelihood of hospital admission.
Objective:
Although 72-hour return visits are a frequently reported metric for pediatric patients discharged from the emergency department (ED), the basis for this metric is not established. Our objective was to statistically derive a cutoff time point for the characterization of pediatric return visits.
Methods:
We performed a retrospective cohort study using data of patients discharged from any of 44 pediatric EDs. We selected the first encounter per patient from January 1 to December 31, 2019, as the index encounter and included the first return visit within 30 days. We constructed a cumulative hazard curve to characterize the timing of return visits and constructed a multivariable adaptive regression spline model to identify a hinge point in return visit presentations. We identified the association between admission for early return visits and admission for late return visits using generalized linear mixed modeling.
Results:
Of 1,986,778 index ED discharges, 193,605 (9.7%) ED return visits were included. A double-exponential decay model demonstrated superior fit compared with a single exponential model ( P < 0.0001). Multivariable adaptive regression spline modeling identified a hinge at 7 days. When comparing proportions of return visits leading to hospitalization between early (23.8%) and late (15.1%) return visits, early visits (≤7 days) had higher adjusted odds of hospital admission (adjusted odds ratio, 1.73; 95% confidence interval, 1.69-1.77) relative to late return visits (>7 days). Findings were similar in sensitivity analyses within age subgroups, Census region, and in which the diagnosis (using the Diagnosis and Grouping System) was the same between the index and return visit. Among return visits that occurred within 7 days of the index visit, 46.3% had the same diagnosis grouping in both visits.
Conclusions:
An empirically derived 7-day cutoff may be more appropriate for characterization of pediatric return visits to the ED. Encounters after this period had lower adjusted odds of admission.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
04:05Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Related Concept Videos
01:18Survival Curves
The Kaplan-Meier estimator is the most common method for constructing survival curves. This...
01:21Cardiopulmonary Resuscitation I: Adult
01:25Interpreting Run Charts
00:58The X̄ Chart
The x̄ chart, often known as the individual control chart, is a crucial tool in statistical process control. It is designed to monitor process behavior and performance over time and is widely used in various industries to ensure that processes are operating at their optimum capacity and within specified limits.
A x̄ chart is constructed by plotting individual measurements of a quality...
01:27Pulmonary Embolism III: Nursing Management
01:04Venous Return
What is Venous Return?
Venous return refers to the rate at which blood flows back to the heart from the body's peripheral veins. It's an integral part of the circulatory system...