title: Noncompliance with scheduled revisits to a pediatric emergency department.
abstract: OBJECTIVE
  To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED).
  
  
  METHODS
  A prospective, inceptive cohort study.
  
  
  METHODS
  An urban pediatric ED.
  
  
  METHODS
  A sample of 179 children.
  
  
  METHODS
  Interviews of parents and physicians.
  
  
  RESULTS
  Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because "the child was better." Of the 124 patients who ED physicians believed were "certain to return," 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged "not certain" to return (RR, 1.34; 95% CI, 1.01-1.78).
  
  
  CONCLUSIONS
  The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.
authors.affiliation: Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pa, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Scarfone
authors.forename: M D
authors.initials: MD
authors.lastname: Joffe
authors.forename: J F
authors.initials: JF
authors.lastname: Wiley
authors.forename: J M
authors.initials: JM
authors.lastname: Loiselle
authors.forename: R T
authors.initials: RT
authors.lastname: Cook
mesh_terms: D001071:Appointments and Schedules; D001294:Attitude to Health; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009042:Motivation; D010290:Parents / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal