A National Depiction of Children With Return Visits to the Emergency Department Within 72 Hours, 2001-2007

Objectives: The objectives of this study were to estimate the frequency of pediatric 72-hour return visits (RVs) to the emergency department (ED) between 2001 and 2007 and to determine demographic and clinical characteristics associated with these RVs. Methods: Data from the National Hospital Ambulatory Medical Care Survey between 2001 and 2007 were analyzed to estimate the frequency of RVs to EDs by children. Patient demographics and clinical variables were compared for RVs and non-RVs using the chi(2) test; RVs were further characterized using multivariable logistic regression. Results: Between 2001 and 2007, there was an annual average of 698,000 RVs by children (2.7% of all ED visits). The RV rate significantly increased from 2001 to 2007. Factors associated with an RV included age younger than 1 year or 13 to 18 years, arrival to the ED between 7 A.M. and 3 P.M., recent discharge from the hospital, and western region of the United States. During ED RVs, a complete blood count was more likely to be obtained, and the patient was more likely to be admitted. Insurance was not associated with an RV to the ED. On RV, patients were less likely to have a diagnosis related to trauma or injury. Conclusions: Analysis of the National Hospital Ambulatory Medical Care Survey database offers a national perspective into EDRVs in children. In this era of increasing utilization, these results can help physicians and policy makers address the unique needs of this population and create interventions that will optimize patient service while attempting to control potentially unnecessary RVs.