Clinical Predictors of Emergency Department Revisitswithin 48 Hours of Discharge; a Case Control Study

Emergency department (ED) revisits increase overcrowding and predicting which patients mayneed to revisit could increase patient safety. This study aimed to identify clinical variables that could be usedto predict the probability of revisiting ED within 48 hours of discharge.

A retrospective case-controlstudy was conducted between July 2018 and January 2019 at the Emergency Medicine Department in Ramathi-bodi Hospital, Bangkok, Thailand. Patients who revisited the ED within 48 hours of discharge (case group) andpatients who did not (control group) participated. The predictive factors for ED revisit were identified throughmultivariate logistic regression analysis.

The case group consisted of 372 patients, who revisited the EDwithin 48 hours, and the control group consisted of 1488 patients. The most common reason for revisiting theED was recurring gastrointestinal illness, in 107 patients (28.76%). According to the multivariate data analysis ,five factors influenced the probability of revisiting the ED: age of more than 60 years (p < 0.001, OR = 2.04, 95%CI:1.51-2.77), initial Emergency Severity Index (ESI) triage level of 2 (p = 0.007, OR = 1.20, 95%CI: 0.93-1.56), ED stayduration of 4 hours or longer (p = 0.013, OR = 1.12, 95%CI: 0.87-1.44), body temperature of≥37.5◦C on discharge(p = 0.034, OR = 1.34, 95%CI: 1.00-1.80), and pulse rate of less than 60 (OR = 1.55, 95%CI: 0.87-2.77) or more than100 beats/minute (OR = 1.53, 95%CI: 1.10-2.11) (p = 0.011).

According to the findings, the mostimportant and independent predictive factor of ED revisit within 48 hours of discharge were, age≥60 years, ESItriage level 2, ED length of stay≥4 hours, temperature≥37.5 C, and 60 > pulse rate≥100 beats/minute.