Longitudinal Trends in Pediatric Return Visits to US Emergency Departments

Sara E. Holmstrom, Selina Varma, Erin Augustine, Paria M. Wilson, Sriram Ramgopal*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives This study aimed to evaluate trends in pediatric emergency department (ED) 72-hour return visits and factors associated with return visits. Methods We performed a cross-sectional study from 2002 to 2018 using the National Hospital Ambulatory Medical Care Survey, a complex survey of nonfederal US ED encounters. Patients 18 years or older were excluded. Our outcome of interest was 72-hour return ED encounter. We assessed changes in proportions of return visits over time using the Spearman rank-correlation test. We performed survey-weighted univariable and multivariable logistic regressions to identify factors associated with 72-hour return visit status. Results A total of 501 million (95% confidence interval [CI], 452-551 million) pediatric survey-weighted ED encounters occurred during the 17-year study period, of which 14,353,697 (3.2%; 95% CI, 2.7%-3.7%) represented 72-hour return visits. The proportion of pediatric ED return visits increased from 22.9 to 36.5 per 1000 pediatric encounters over the study period (ρ = 0.68, P < 0.01). Most return visits were of lower acuity (73.0%; 95% CI, 68.6%-11.5%), and 8.1% (95% CI, 6.3%-9.9%) of return visits were admitted to the hospital or transferred to a different facility. In multivariable analyses, older age, abnormal heart rate, and abnormal temperature had lower adjusted odds ratio (aOR) of 72-hour return visits compared with encounters not classified as return visit. Complaints of returning for test results, treatment, and diagnostic screening/administrative purposes were associated with a higher aOR of return visit. Admission/transfer (in comparison with discharge) had a higher odds of return visit status in univariable (odds ratio, 1.59; 95% CI, 1.24-2.04) and multivariable (aOR, 1.31; 95% CI, 1.03-1.68) analyses. Conclusions The proportion of 72-hour US pediatric ED return visits is increasing over time. Return visit status was associated with admission/transfer, but otherwise with markers of lower patient acuity. These findings inform quality improvement efforts aimed at improving pediatric transition to outpatient care after an ED encounter.

Original languageEnglish (US)
Pages (from-to)E1237-E1244
JournalPediatric emergency care
Issue number5
StatePublished - May 1 2022


  • emergency service, hospital
  • patient acuity
  • quality improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine


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