Prevalence and predictors of return visits to pediatric emergency departments. Issue 12 (23rd October 2014)

• Record Type: Journal Article
• Authors: Akenroye, Ayobami T.; Thurm, Cary W.; Neuman, Mark I.; Alpern, Elizabeth R.; Srivastava, Geetanjali; Spencer, Sandra P.; Simon, Harold K.; Tejedor‐Sojo, Javier; Gosdin, Craig H.; Brennan, Elizabeth; Gottlieb, Laura M.; Gay, James C.; McClead, Richard E.; Shah, Samir S.; Stack, Anne M.
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 12(2014)
• Page Start: 779
• Page End: 787
• Publication Date: 2014-10-23
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2273
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2273-sec-0001" sec-type="section"> <title>OBJECTIVE</title> <p>To determine the rate of return visits to pediatric emergency departments (EDs) and identify patient‐ and visit‐level factors associated with return visits and hospitalization upon return.</p> </sec> <sec id="jhm2273-sec-0002" sec-type="section"> <title>DESIGN AND SETTING</title> <p>Retrospective cohort study of visits to 23 pediatric EDs in 2012 using data from the Pediatric Health Information System.</p> </sec> <sec id="jhm2273-sec-0003" sec-type="section"> <title>PARTICIPANTS</title> <p>Patients <18 years old discharged following an ED visit.</p> </sec> <sec id="jhm2273-sec-0004" sec-type="section"> <title>MEASURES</title> <p>The primary outcomes were the rate of return visits within 72 hours of discharge from the ED and of return visits within 72 hours resulting in hospitalization. Results: 1, 415, 721 of the 1, 610, 201 ED visits to study hospitals resulted in discharge. Of the discharges, 47, 294 patients (3.3%) had a return visit. Of these revisits, 9295 (19.7%) resulted in hospitalization. In multivariate analyses, the odds of having a revisit were higher for patients with a chronic condition (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.86‐1.96), higher severity scores (OR: 1.42, 95% CI: 1.40‐1.45), and age <1 year (OR: 1.32, 95% CI: 1.22‐1.42). The odds of hospitalization on return were higher for patients with higher severity (OR: 3.42, 95% CI: 3.23‐3.62), chronic conditions (OR: 2.92, 95% CI: 2.75‐3.10), age <1 year (1.7–2.5 times the odds of other age groups), overnight arrival (OR: 1.84, 95% CI: 1.71‐1.97), and private insurance (OR: 1.47, 95% CI: 1.39‐1.56). Sickle cell disease and cancer patients had the highest rates of return at 10.7% and 7.3%, respectively.</p> </sec> <sec id="jhm2273-sec-0005" sec-type="section"> <title>CONCLUSIONS</title> <p>Multiple patient‐ and visit‐level factors are associated with revisits. These factors may provide insight in how to optimize care and decrease avoidable ED utilization. <italic>Journal of Hospital Medicine</italic> 2014;9:779–787. © 2014 Society of Hospital Medicine</p> </sec> </abstract>