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. 2022 Oct 18;23(6):832-840.
doi: 10.5811/westjem.2022.7.57028.

High-risk Return Visits to United States Emergency Departments, 2010-2018

Dean-An Ling  1 , Chih-Wei Sung  2 , Cheng-Chung Fang  1   3 , Chia-Hsin Ko  1 , Eric H Chou  4 , Jeffrey Herrala  5 , Tsung-Chien Lu  1   3 , Chien-Hua Huang  1   3 , Chu-Lin Tsai  1   3
Affiliations

High-risk Return Visits to United States Emergency Departments, 2010-2018

Dean-An Ling et al. West J Emerg Med. .

Abstract

Introduction: Although factors related to a return visit to the emergency department (ED) have been reported, only a few studies have examined "high-risk" ED revisits with serious adverse outcomes. In this study we aimed to describe the incidence and trend of high-risk ED revisits in United States EDs and to investigate factors associated with these revisits.

Methods: We obtained data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 2010-2018. Adult ED revisits within 72 hours of a previous discharge were identified using a mark on the patient record form. We defined high-risk revisits as revisits with serious adverse outcomes, including intensive care unit admissions, emergency surgery, cardiac catheterization, or cardiopulmonary resuscitation (CPR) during the return visit. We performed analyses using descriptive statistics and multivariable logistic regression, accounting for NHAMCS's complex survey design.

Results: Over the nine-year study period, there were an estimated 37,700,000 revisits, and the proportion of revisits in the entire ED population decreased slightly from 5.1% in 2010 to 4.5% in 2018 (P for trend = 0.02). By contrast, there were an estimated 827,000 high-risk ED revisits, and the proportion of high-risk revisits in the entire ED population remained stable at approximately 0.1%. The mean age of these high-risk revisit patients was 57 years, and 43% were men. Approximately 6% of the patients were intubated, and 13% received CPR. Most of them were hospitalized, and 2% died in the ED. Multivariable analysis showed that older age (65+ years), Hispanic ethnicity, daytime visits, and arrival by ambulance during the revisit were independent predictors of high-risk revisits.

Conclusion: High-risk revisits accounted for a relatively small fraction (0.1%) of ED visits. Over the period of the NHAMCS survey between 2010-2018, this fraction remained stable. We identified factors during the return visit that could be used to label high-risk revisits for timely intervention.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. This project was supported by grants from the Ministry of Science and Technology (111-2634-F-002-015 and 111-2314-B-002-264) and the National Taiwan University Hospital (111-CGN-0005). There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient selection process. ED, emergency department.
Figure 2
Figure 2
The number and proportion of overall emergency department revisits, 2010–2018. ED, emergency department.
Figure 3
Figure 3
The number and proportion of overall emergency department high-risk revisits, 2010–2018. The error bars represent 95% confidence intervals. ED, emergency department.
See this image and copyright information in PMC

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