Comparing Pediatric 72-Hour Emergency Department Returns: General vs Pediatric Emergency Departments

There is limited data comparing pediatric return visits between pediatric emergency departments (PED) and general EDs. We hypothesized that the 72-hour return rate is higher for patients discharged from general EDs than from PEDs.

We analyzed all PED visits in a large, national emergency medical group that had a repeat ED visit to the same site within 72 hours between 2016-2019. Associated visit- and facility-level characteristics analyzed in the model included patient age, Emergency Severity Index and triage level, sex, insurance type, categorized reason for visit, facility type, facility size, trauma status, teaching status, year, and month. Diagnostic categories were defined using the Agency for Healthcare Research and Quality clinical classification software for diagnosis codes. The outcome variable was 72-hour returns. We analyzed returns at the visit-level using descriptive statistics and at the facility-month level using logistic regression to adjust for potential confounders.

A total of 2,588,680 pediatric visits were included: 1,821,800 from 137 general EDs and 766,880 from 7 PEDs. The proportion of children returning to a PED within 72 hours was 1.1 percentage points higher than at a general ED (3.5% vs. 2.4%). The adjusted odds ratio for a 72-hour return visit was 1.3 (confidence interval 1.15-1.38) in PEDs compared to general EDs.

Pediatric patients discharged from PEDs had a higher rate of 72-hour return visits than those discharged from general EDs. These findings merit further investigation into factors driving these differences to identify best practices and optimize care across ED settings.