Emergency department revisit rates underestimated among pediatric patients

1. Emergency department (ED) revisit rates among pediatric patients were shown to be underestimated by almost 20% when only revisits that occurred at the same hospital as the original visit were considered.

2. Patients initially seen at institutions with the lowest annual pediatric volumes were more likely to have revisits at a different hospital compared to patients with index visits at hospitals with the largest pediatric volumes.

Evidence Rating Level: 4 (Below Average)

Study Rundown: While ED revisit rates are often used as an indication of department and hospital quality of care, data generally only include revisits that happen at the same hospital, potentially leading to underestimation of the true revisit rates. Researchers in this study analyzed data discharges among pediatric patients from 261 EDs in New York and Maryland to quantify revisit rates at the same (SHR) and different (DHR) facilities. They also sought to describe predictors of ED revisits and to determine the possible underestimation of revisit rates by comparing all facility revisits to SHR only. Results showed revisit rates within 7 days were underestimated by almost 20% among children <18 years when DHR facilities were not taken into consideration. Revisits occurred in about 1 of every 20 pediatric patients who were discharged from a participating ED, and of all revisits, about 1 in 5 happened at DHRs. DHRs were found to be significantly more common among patients initially seen at EDs with lower pediatric volumes. This study was limited by an inability to determine revisits for index sites on the last day of the study period. In cases where revisits occurred on the same day as the index visits, researchers were not able to determine which visit occurred first, thus these visits were excluded. Lack of data on both these circumstances likely contributed to an underestimation of the revisit rates. Results from this study suggest ED revisit rates among pediatric patients are significantly underestimated when analyzing data from individual institutions only.

Click to read the study, published today in Pediatrics

Relevant reading: Patients visiting multiple emergency departments: patterns, costs, and risk factors

In-depth [cross-sectional]: Researchers analyzed data from 4.3 million ED visits in patients <18 years old at 261 EDs in New York and Maryland. Revisits were defined as visits which occurred between 1 and 7 days after the initial visit. Emergency departments were grouped into 4 quartiles based on annual pediatric volume. Results showed that a total of 250 856 (5.9%) patients had revisits, of which 43 630 (17.4%) were DHR. Patients originally seen at institutions with the highest annual pediatric volume were significantly less likely to have DHR compared with patients seen at centers with the lowest pediatric volumes (adjusted odds ratio [aOR] 0.27, 95%CI 0.19-0.36). Patients see at institutions with the highest proportion of Medicaid patients were 1.49 times as likely to have a revisit compared to those seen at institutions with the lowest proportion of Medicaid patients (OR 1.49, 95% CI 1.35-1.65). Revisit rates were highest among patients initially diagnosed with unspecified fever (6.6% index visits leading to revisits), upper respiratory tract infections (6.2%), and unspecified viral infections (5.1%). DHRs were associated with admissions in 28.8% of cases compared to 10.4% of cases in SHR (OR 3.93, 95% CI 3.83-4.04).

Image: CC/Wiki/Eyone ambulance emergency

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