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

Author:

Coleman Keli D.1ORCID,McKinley Kenneth2,Ellison Angela M.3,Alpern Elizabeth R.4,Hariharan Selena5,Topoz Irina6,Wurtz Morgan7,Nielsen Blake8,Cook Lawrence J.8,Morris Claudia R.9,Brandow Amanda M.10ORCID,Campbell Andrew D.11ORCID,Liem Robert I.12ORCID,Nuss Rachelle13ORCID,Quinn Charles T.14ORCID,Thompson Alexis A.15,Villella Anthony7,King Allison A.16ORCID,Baumann Ana17,Frankenberger Warren15,Brousseau David C.18

Affiliation:

1. Department of Pediatrics, Section of Emergency Medicine Medical College of Wisconsin and the Children's Research Institute of Children's Wisconsin Milwaukee Wisconsin USA

2. Children's National Medical Center Washington District of Columbia USA

3. Department of Pediatrics Children's Hospital of Philadelphia Philadelphia Pennsylvania USA

4. Department of Pediatrics Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine Chicago Illinois USA

5. University of Cincinnati College of Medicine, Cincinnati Children's Hospital Cincinnati Ohio USA

6. Department of Pediatrics, Section of Emergency Medicine Children's Hospital Colorado Aurora Colorado USA

7. Nationwide Children's Hospital Columbus Ohio USA

8. University of Utah Salt Lake City Utah USA

9. Department of Pediatrics Emory University School of Medicine and Children's Healthcare of Atlanta Atlanta Georgia USA

10. Department of Pediatrics Section of Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin and Children's Research Institute of Children's Wisconsin Milwaukee Wisconsin USA

11. Center for Cancer and Blood Disorders, Children's National Hospital Washington District of Columbia USA

12. Division of Hematology, Oncology & Stem Cell Transplant Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA

13. Center for Cancer and Blood Disorders University of Colorado Anschutz Medical Campus Aurora Colorado USA

14. Division of Hematology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA

15. Children's Hospital of Philadelphia Philadelphia Pennsylvania USA

16. Pediatric Hematology/Oncology Washington University School of Medicine St. Louis Missouri USA

17. Washington University School of Medicine St. Louis Missouri USA

18. Nemours Children's Health and Sidney Kimmel Medical College at Thomas Jefferson University Wilmington Delaware USA

Abstract

AbstractBackgroundHigh 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.ProcedureA 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.ResultsOf 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.ConclusionNearly 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.

Publisher

Wiley

Subject

Oncology,Hematology,Pediatrics, Perinatology and Child Health

Reference32 articles.

1. Sickle cell disease. Accessed May 24 2023.CDC.https://www.cdc.gov/ncbddd/sicklecell/data.html

2. The number of people with sickle cell disease in the United States: National and state estimates

3. Population Estimates of Sickle Cell Disease in the U.S.

4. Sickle disease in children;Meier ER;Drugs,2012

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