Saudi Journal of Emergency Medicine

Original Article
SJEMed. 2022; 3(1): 080-087

Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study

Authors: Rasha D. Sawaya, Sarah S. Abdul Nabi, Rima Kaddoura, Hani Tamim, Ziad Obermeyer, Eveline Hitti.

View PDF HTML Fulltext DOI: 10.24911/SJEMed/72-1612001910

Abstract

Background and Objective: High-risk unscheduled return visits (HRURVs) are a key quality metric in the Emergency Department (ED). We, therefore, aimed to determine their incidence and clinical predictors in the pediatric ED. Design: This is a case control study. Setting: This study was conducted in the pediatric ED of an Eastern Mediterranean tertiary care hospital. Participants: Cases included HRURVs ≤18 years old that presented to the ED between November 1, 2014, and October 31, 2015. Controls included patients discharged from the ED during this period and who did not return within 72 hours. Controls were matched 1:1 based on age, gender and date of presentation (±7 days). Out of 14,805 Pediatric ED visits, 142 were HRURVs, with an incidence of 0.96% [95% confidence intervals (CI) 0.81 to 1.13]. Our final analysis included 139 HRURV cases and 139 controls. 3 were excluded because of incomplete charts. Main Outcome Measures: The outcome, HRURV was defined as an ED return visit within 72 hours that required admission or died in the ED. Results: Of the cases, 2.6% were admitted to the intensive care unit and 7.19% required surgical intervention. Cases were more likely to be hospitalised in the last 30 days [adjusted odds ratio (AOR) 19.53, 95% CI 2.45 to 155.44], have more laboratories ordered (AOR 3.74, 95% CI 2.15 to 6.48), present with a temperature > 38.5°C (AOR 2.63, 95% CI 1.26 to 5.48) and have a discharge diagnosis related to the digestive system (AOR 1.96, 95% CI 1.04 to 3.72). Receiving at least one medication at the index visit was a negative predictor (AOR 0.35, 95% CI 0.19 to 0.63). Conclusion: Efforts to reduce HRURVs should focus on the clinical predictors identified. Receiving medications in the ED appears to be protective requiring further research to identify medication categories driving this finding.

Keywords:   Emergency Department, high risk unscheduled return visits, bounceback, Pediatrics


© Copyright: Author(s)

Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study


Authors
Rasha D Sawaya
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Sarah S Abdul Nabi
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Rima Kaddoura
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hani Tamim
Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Ziad Obermeyer
Department of Emergency Medicine, Division of Health Policy and Management, University of California Berkeley, Berkeley, CA
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Eveline Hitti
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Correspondence to:
. Eveline Hitti, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.; eh16@aub.edu.lb

Publication history
Received 30 Jan 2021
Revised 17 Jun 2021
Accepted 23 Nov 2021
Published online 16 Dec 2021
Published in print 07 Mar 2022

How to cite this article

Pubmed Style

Sawaya RD, Nabi SSA, Kaddoura R, Tamim H, Obermeyer Z, Hitti E. Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. SJEMed. 2022; 3(1): 080-087. doi:10.24911/SJEMed/72-1612001910


Web Style

Sawaya RD, Nabi SSA, Kaddoura R, Tamim H, Obermeyer Z, Hitti E. Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. https://www.sjemed.com/?mno=50540 [Access: July 02, 2022]. doi:10.24911/SJEMed/72-1612001910


AMA (American Medical Association) Style

Sawaya RD, Nabi SSA, Kaddoura R, Tamim H, Obermeyer Z, Hitti E. Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. SJEMed. 2022; 3(1): 080-087. doi:10.24911/SJEMed/72-1612001910


Vancouver/ICMJE Style

Sawaya RD, Nabi SSA, Kaddoura R, Tamim H, Obermeyer Z, Hitti E. Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. SJEMed. (2022), [cited July 02, 2022]; 3(1): 080-087. doi:10.24911/SJEMed/72-1612001910


Harvard Style

Sawaya, R. D., Nabi, . S. S. A., Kaddoura, . R., Tamim, . H., Obermeyer, . Z. & Hitti, . E. (2022) Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. SJEMed, 3 (1), 080-087. doi:10.24911/SJEMed/72-1612001910


Turabian Style

Sawaya, Rasha D., Sarah S. Abdul Nabi, Rima Kaddoura, Hani Tamim, Ziad Obermeyer, and Eveline Hitti. 2022. Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. Saudi Journal of Emergency Medicine, 3 (1), 080-087. doi:10.24911/SJEMed/72-1612001910


Chicago Style

Sawaya, Rasha D., Sarah S. Abdul Nabi, Rima Kaddoura, Hani Tamim, Ziad Obermeyer, and Eveline Hitti. "Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study." Saudi Journal of Emergency Medicine 3 (2022), 080-087. doi:10.24911/SJEMed/72-1612001910


MLA (The Modern Language Association) Style

Sawaya, Rasha D., Sarah S. Abdul Nabi, Rima Kaddoura, Hani Tamim, Ziad Obermeyer, and Eveline Hitti. "Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study." Saudi Journal of Emergency Medicine 3.1 (2022), 080-087. Print. doi:10.24911/SJEMed/72-1612001910


APA (American Psychological Association) Style

Sawaya, R. D., Nabi, . S. S. A., Kaddoura, . R., Tamim, . H., Obermeyer, . Z. & Hitti, . E. (2022) Predictors of high-risk unscheduled return visits to the pediatric emergency department: a case-control study. Saudi Journal of Emergency Medicine, 3 (1), 080-087. doi:10.24911/SJEMed/72-1612001910


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