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Repeat pediatric visits to a general emergency department
D R Zimmerman1, K A McCarten-Gibbs, D H DeNoble
1Department of Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.
Insights
Children with public insurance or under two years old were more likely to have repeat emergency department visits. These repeat visits, often for respiratory issues, were frequently unanticipated and lacked clear medical necessity.
Area of Science:
- Pediatrics
- Emergency Medicine
- Health Services Research
Background:
- Unplanned pediatric emergency department (ED) visits represent a significant healthcare burden.
- Understanding factors associated with repeat ED visits is crucial for optimizing resource allocation and improving patient care.
Purpose of the Study:
- To determine the incidence of repeat visits among pediatric patients in a general emergency department.
- To identify demographic and clinical factors associated with these repeat visits.
Main Methods:
- A retrospective chart review was conducted for 4,276 children under 18 years old treated at a general hospital's ED between July 1992 and June 1993.
- Repeat visits were defined as subsequent visits within 14 days of the initial encounter.
Main Results:
- A total of 291 repeat visits occurred in 245 children within the 14-day period.
- Children with public insurance had a significantly increased risk (MHOR 2.57-2.70) of repeat visits.
- Younger children (under 2 years) also showed a higher risk (MHOR 1.67-1.89) of repeat visits, independent of insurance or race.
Conclusions:
- Repeat ED visits were more common for respiratory diagnoses and less frequent for minor trauma.
- Patients residing in poorer census tracts were more likely to have both initial and repeat ED visits compared to those in more affluent areas.
Study Objective:
To determine the rate of repeat visits among children cared for in a general emergency department and associated demographic and clinical variables.
Methods:
We carried out a chart review of patients seen in the ED of a general hospital serving both inner-city and suburban populations. Our subjects were all children younger than 18 years seen in the study ED between July 1, 1992, and June 30, 1993 (N = 4,276).
Results:
We found 291 repeat visits (defined as a subsequent visit within 14 days) n 245 children. Among the 242 repeat visits for related complaints, 200 were unanticipated and most without a clear medical need. Mantel-Haenszel adjusted odds ratios (MHORs) showed a significantly increased risk of repeat visit with public insurance (controlled for age: MHOR, 2.57, and 95% confidence interval [CI], 1.93 to 3.43; controlled for race: MHOR, 2.70, and 95% CI, 1.99 to 3.66) and age younger than 2 years (controlled for insurance MHOR, 1.67, and 95% CI, 1.27 to 2.19; controlled for race: MHOR, 1.89, and 95% CI, 1.47 to 2.47.
Conclusion:
Repeat visits were more likely for respiratory diagnoses and less likely for minor trauma. Both visits and repeat visits were more likely in patients from poorer census tracts than in those from equidistant, more affluent ones.