Return visit rates after an emergency department discharge for children with sickle cell pain episodes

Keli D. Coleman*, Kenneth McKinley, Angela M. Ellison, Elizabeth R. Alpern, Selena Hariharan, Irina Topoz, Morgan Wurtz, Blake Nielsen, Lawrence J. Cook, Claudia R. Morris, Amanda M. Brandow, Andrew D. Campbell, Robert I. Liem, Rachelle Nuss, Charles T. Quinn, Alexis A Thompson, Anthony Villella, Allison A. King, Ana Baumann, Warren FrankenbergerDavid C. Brousseau

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: High return visit rates after hospitalization for people with sickle cell disease (SCD) have been previously established. Due to a lack of multicenter emergency department (ED) return visit rate data, the return visit rate following ED discharge for pediatric SCD pain treatment is currently unknown. Procedure: A seven-site retrospective cohort study of discharged ED visits for pain by children with SCD was conducted using the Pediatric Emergency Care Applied Research Network Registry. Visits between January 2017 and November 2021 were identified using previously validated criteria. The primary outcome was the 14-day return visit rate, with 3- and 7-day rates also calculated. Modified Poisson regression was used to analyze associations for age, sex, initial hospitalization rate, and a visit during the COVID-19 pandemic with return visit rates. Results: Of 2548 eligible ED visits, approximately 52% were patients less than 12 years old, 50% were female, and over 95% were non-Hispanic Black. The overall 14-day return visit rate was 29.1% (95% confidence interval [CI]: 27.4%–30.9%; site range 22.7%–31.7%); the 7- and 3-day return visit rates were 23.0% (95% CI: 21.3%–24.6%) and 16.7% (95% CI: 15.3%–18.2%), respectively. Younger children had slightly lower 14-day return visit rates (27.3% vs. 31.1%); there were no associations for site hospitalization rate, sex, and a visit occurring during the pandemic with 14-day returns. Conclusion: Nearly 30% of ED discharged visits after SCD pain treatment had a return visit within 14 days. Increased efforts are needed to identify causes for high ED return visit rates and ensure optimal ED and post-ED care.

Original languageEnglish (US)
Article numbere30553
JournalPediatric Blood and Cancer
Volume70
Issue number10
DOIs
StatePublished - Oct 2023

Funding

We would like to thank Mark Nimmer (Medical College of Wisconsin, Section of Pediatric Emergency Medicine) for his support with manuscript preparation and editing. We would like to thank the PECARN Registry Study Group and investigators for their contributions to the PECARN Registry. This project was supported by the National Heart, Lung, Blood Institute (NHLBI) under grant award number 1U01HL159850 and PECARN funding for involved nodes by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), in the Maternal and Child Health Bureau (MCHB), under the Emergency Medical Services for Children (EMSC) program through the following cooperative agreements: DCC–University of Utah, GLEMSCRN‐Nationwide Children's Hospital, HOMERUN–Cincinnati Children's Hospital Medical Center, PEMNEWS–Columbia University Medical Center, PRIME–University of California at Davis Medical Center. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government. We would like to thank Mark Nimmer (Medical College of Wisconsin, Section of Pediatric Emergency Medicine) for his support with manuscript preparation and editing. We would like to thank the PECARN Registry Study Group and investigators for their contributions to the PECARN Registry. This project was supported by the National Heart, Lung, Blood Institute (NHLBI) under grant award number 1U01HL159850 and PECARN funding for involved nodes by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), in the Maternal and Child Health Bureau (MCHB), under the Emergency Medical Services for Children (EMSC) program through the following cooperative agreements: DCC–University of Utah, GLEMSCRN-Nationwide Children's Hospital, HOMERUN–Cincinnati Children's Hospital Medical Center, PEMNEWS–Columbia University Medical Center, PRIME–University of California at Davis Medical Center. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.

Keywords

  • children
  • emergency department
  • pain
  • sickle cell

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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