Akenroye Ayobami T, Thurm Cary W, Neuman Mark I, Alpern Elizabeth R, Srivastava Geetanjali, Spencer Sandra P, Simon Harold K, Tejedor-Sojo Javier, Gosdin Craig H, Brennan Elizabeth, Gottlieb Laura M, Gay James C, McClead Richard E, Shah Samir S, Stack Anne M
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
J Hosp Med. 2014 Dec;9(12):779-87. doi: 10.1002/jhm.2273. Epub 2014 Oct 23.
To determine the rate of return visits to pediatric emergency departments (EDs) and identify patient- and visit-level factors associated with return visits and hospitalization upon return.
Retrospective cohort study of visits to 23 pediatric EDs in 2012 using data from the Pediatric Health Information System.
Patients <18 years old discharged following an ED visit.
The primary outcomes were the rate of return visits within 72 hours of discharge from the ED and of return visits within 72 hours resulting in hospitalization.
1,415,721 of the 1,610,201 ED visits to study hospitals resulted in discharge. Of the discharges, 47,294 patients (3.3%) had a return visit. Of these revisits, 9295 (19.7%) resulted in hospitalization. In multivariate analyses, the odds of having a revisit were higher for patients with a chronic condition (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.86-1.96), higher severity scores (OR: 1.42, 95% CI: 1.40-1.45), and age <1 year (OR: 1.32, 95% CI: 1.22-1.42). The odds of hospitalization on return were higher for patients with higher severity (OR: 3.42, 95% CI: 3.23-3.62), chronic conditions (OR: 2.92, 95% CI: 2.75-3.10), age <1 year (1.7-2.5 times the odds of other age groups), overnight arrival (OR: 1.84, 95% CI: 1.71-1.97), and private insurance (OR: 1.47, 95% CI: 1.39-1.56). Sickle cell disease and cancer patients had the highest rates of return at 10.7% and 7.3%, respectively.
Multiple patient- and visit-level factors are associated with revisits. These factors may provide insight in how to optimize care and decrease avoidable ED utilization.
确定儿科急诊科复诊率，并识别与复诊及复诊后住院相关的患者和就诊层面因素。
利用儿科健康信息系统的数据，对2012年23家儿科急诊科的就诊情况进行回顾性队列研究。
急诊科就诊后出院的18岁以下患者。
主要结局为急诊科出院后72小时内的复诊率以及72小时内导致住院的复诊率。
研究医院的1610201次急诊科就诊中有1415721次导致出院。在出院患者中，47294名患者（3.3%）进行了复诊。在这些复诊中，9295例（19.7%）导致住院。多因素分析显示，患有慢性病的患者复诊几率更高（比值比[OR]：1.91，95%置信区间[CI]：1.86 - 1.96）、病情严重程度评分更高（OR：1.42，95% CI：1.40 - 1.45）以及年龄<1岁（OR：1.32，95% CI：1.22 - 1.42）。复诊后住院几率更高的患者包括病情更严重者（OR：3.42，95% CI：3.23 - 3.62）、患有慢性病者（OR：2.92，95% CI：2.75 - 3.10）、年龄<1岁者（是其他年龄组几率的1.7 - 2.5倍）、夜间就诊者（OR：1.84，95% CI：1.71 - 1.97）以及有私人保险者（OR：1.47，95% CI：1.39 - 1.56）。镰状细胞病和癌症患者的复诊率最高，分别为10.7%和7.3%。
多种患者和就诊层面因素与复诊相关。这些因素可能有助于深入了解如何优化医疗护理并减少不必要的急诊科利用。
