Children Admitted to the Hospital After Returning to the Emergency Department Within 72 Hours

Abstract

More than 4% of our pediatric ED visits are for children returning within 72 hours. Progression of illness resulting in higher acuity, not age, sex, time from previous visit, or change in chief complaint category, was associated directly with admission on the second visit.

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

“…This was higher than the overall admission rate of 16.5% among ED patients at our institution over the same duration, which is a trend seen in most other EDs. (2,3,7) Physicians may be more inclined to order additional investigations or have a lower threshold to admit patients at the return visit. (3) For the paediatric population, parental anxiety plays a major role in influencing the disposition of the child.…”

“…Patients returning to the ED within 72 hours of their initial presentation may contribute to overcrowding, (1)(2)(3)(4) which can lead to delayed treatment, patient dissatisfaction, straining of ED resources and increased healthcare costs. (1,2,5,6) Reattendances may be due to illness progression (3,7,8) or parental preference for ED care, (5) but may also reflect failure to appropriately diagnose, treat and communicate follow-up advice at the first visit. (2,3,(7)(8)(9) In the paediatric population, parental concern or anxiety may play a significant role.…”

“…(1,2,5,6) Reattendances may be due to illness progression (3,7,8) or parental preference for ED care, (5) but may also reflect failure to appropriately diagnose, treat and communicate follow-up advice at the first visit. (2,3,(7)(8)(9) In the paediatric population, parental concern or anxiety may play a significant role. (3,7,10) Higher reattendance rates may, therefore, indicate suboptimal clinical care or failure to address parental concerns at the first visit.…”

“…(8) A majority of studies have associated reattendance with young age; higher acuity; attendance during the busiest hours; presence of chronic illness; infectious disease or respiratory diagnoses; and higher rates of admission. (1)(2)(3)7,9,13) In particular, children with chronic diseases have complex multidisciplinary care needs and may present to the ED more frequently when alternative sources of care are not available. (14)(15)(16) In the present study, our primary objective was to determine the rate and characteristics of reattendances at our paediatric ED within 72 hours from the first visit.…”

Consultas ambulatorias pediátricas atendidas en el Servicio de Urgencia de un hospital universitario

“…Los principales factores de riesgo de hospitalización fueron el período de RN y las consultas por ictericia, síntomas neurológicos e intoxicaciones. Finalmente, la tasa de consultas repetidas fue similar a lo comunicado en otros estudios (3,9% vs 2,7-5,2%) [24][25][26][27][28] ; lo cual puede ser explicado por el perfil sociodemográfico y clínico de los pacientes que consultan en nuestro SU, donde los médicos pediatras citan a control a los pacientes en el SU como alternativa a la hospitalización o a su derivación a los servicios de atención primaria.…”