Children admitted to the hospital after returning to the emergency department within 72 hours.

OBJECTIVES: Children returning to the emergency department (ED) within 72 hours of their visit may increase overcrowding and health care costs. Identifying the characteristics of returning children who need admission may help distinguish who might need admission on their first visit. The objective of this study was to compare the characteristics of children who returned to the ED and needed admission to the characteristics of those discharged.

METHODS: The study used a retrospective chart review of patients 19 years and younger visiting a tertiary pediatric ED during a 1-year period. We excluded patients who left without being seen and those leaving against medical advice. We determined the rate of return visits and then performed χ² and Student t test analyses. Main outcome measures were return and subsequent hospital admission rate to the ED.

RESULTS: Of 47,655 eligible children, 2115 (4.4%) returned to the ED within 72 hours. The admission rate for the second visit was 353 (16.7%). There was no significant difference in age, sex, language spoken at home, or time elapsing from the first visit to the re-presentation to the ED between children who needed admission on the returned visit and those discharged when returning. The acuity was significantly lower among children discharged after returning (P < 0.001) but not among those admitted (P < 0.22).

CONCLUSIONS: 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.