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Risk Factors Associated With Emergency Department Revisits and Subsequent Hospitalizations in Previously Healthy
Deanna Hano1, Patricia Hametz2, Karen Warman3
1Department of Pediatrics, Weill Cornell Medicine, New York, New York.
Insights
Younger boys with croup treated with certain medications or imaging in the emergency department (ED) are more likely to return to the ED and be hospitalized. These factors should guide discharge planning for pediatric croup patients.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Illnesses in Children
- Healthcare Outcomes Research
Background:
- Croup is a common childhood respiratory illness often managed in emergency departments (EDs).
- Predicting which children are at higher risk for ED revisits after croup discharge is crucial for optimizing care.
- Current understanding of factors influencing croup revisit rates and subsequent hospitalizations is limited.
Purpose of the Study:
- To identify patient-related and care-related factors associated with increased odds of ED revisits within 3 days of discharge for croup.
- To investigate factors linked to subsequent hospitalizations after an ED revisit for croup.
Main Methods:
- Retrospective multicentered cohort study utilizing the Pediatric Health Information System database.
- Inclusion of previously healthy patients aged 6 months to 6 years diagnosed with croup between January 2016 and December 2022.
- Multivariable mixed-effects logistic regression analyses to evaluate predictors of ED revisit and subsequent hospital admission.
Main Results:
- Out of 270,919 croup patients discharged from the ED, 4.6% revisited within 3 days; 15.6% of those required hospital admission.
- Younger age, male sex, and receiving racemic epinephrine and/or steroids were associated with higher odds of ED revisits and admission.
- Treatments like antipyretics, bronchodilators, daytime presentation, chest/neck imaging, and electrolyte testing also correlated with increased revisit and admission rates.
Conclusions:
- Age, sex, and specific initial ED treatments, tests, and imaging are significant risk factors for croup revisit and hospitalization.
- These identified factors should be incorporated into anticipatory guidance and discharge planning for pediatric croup patients.
- Enhanced risk stratification can improve care coordination and reduce healthcare utilization for children with croup.
Background And Objective:
It is unclear which children are more likely to return to the emergency department (ED) after an ED discharge for croup. We investigated patient-related and care-related factors associated with increased odds of ED revisits and subsequent hospitalizations within 3 days of ED discharge after treatment of croup.
Methods:
This retrospective multicentered cohort study used the Pediatric Health Information System database. Previously healthy patients aged 6 months to 6 years who presented to pediatric EDs between January 2016 and December 2022 with a primary diagnosis of croup were included. Characteristics of the ED revisit and nonrevisit groups were compared, and multivariable mixed-effects logistic regression analyses were used to evaluate ED revisit within 3 days of discharge and hospital admission after an ED revisit.
Results:
Of 270 919 unique patients with croup seen and discharged from the ED, 12 470 (4.6%) revisited the ED within 3 days of discharge and 1949 (15.6%) of those who revisited the ED required subsequent hospital admission. Specific patient- and care-related factors were associated with higher odds of ED revisits and need for subsequent admission. Patients who were younger, boys, received racemic epinephrine and/or steroids, received antipyretics or bronchodilators, had chest and/or neck imaging, had electrolyte testing, or presented during the daytime had higher odds of revisiting the ED and requiring subsequent admission.
Conclusion:
This study suggests consideration of additional risk factors such as age, sex, initial ED treatments, tests, and imaging received when providing appropriate anticipatory guidance and discharge planning for children evaluated in EDs for croup.
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