Evaluation of unplanned reattendances to the pediatric emergency department - a five-year study

Background Unplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of UR. Study design We performed a retrospective, single-center cohort study of patients < 18 years old who visited the ED between January 2018 and March 2023. UR was defined as a revisit within 72 h of the index ED visit. We collected data on demographics, attendance data and clinical characteristics. Logistic regression was performed for factors independently associated with UR, after adjusting for age, patient acuity, timing of attendance, presence of senior doctor supervision, rotation months for junior doctors, and diagnostic category. Results Out of the 544,699 eligible children, 24,733 (4.5%) reattended the ED within 72 h, of which 10,915 (44.1%) of them were hospitalized on their reattendance visit. The independent factors associated with UR were young age (age < 3 years old: aOR 1.585 95%CI 1.481-1.698, p < 0.001), high acuity P2+ (aOR 1.398 95%CI 1.354-1.444, p < 0.001), attendance in the evening (aOR 1.086 95%CI 1.055-1.117, p < 0.001) and night (aOR 1.365 95%CI 1.314-1.417, p < 0.001), gastrointestinal diagnosis (aOR 1.528, CI 1.469-1.588; p < 0.001) and respiratory diagnosis (aOR 1.155, CI 1.121-1.189, p < 0.001). Conclusions We identified independent risk factors for UR that could guide resource allocation. Future studies should investigate if targeted interventions may reduce UR in these at-risk populations.