title: Repeated emergency department visits among children admitted with meningitis or septicemia: a population-based study.
abstract: OBJECTIVE
  Early diagnosis of children with meningitis or septicemia remains a significant challenge in emergency medicine. We seek to describe the frequency of repeated emergency department (ED) visits among children admitted with meningitis or septicemia in Ontario, Canada.
  
  
  METHODS
  In this retrospective cohort study, using health administrative data, we included all children aged 30 days to 5 years who were hospitalized with a final diagnosis of meningitis or septicemia in Ontario between 2005 and 2010. ED visits at any hospital in the preceding 5 days were identified as potential repeated ED visits. We used generalized estimating equations to model the association of sex, age, triage score, immunocompromised state, visit timing, type of ED, and annual patient volume on the risk of repeated ED visits.
  
  
  RESULTS
  Of 521 children, 114 (21.9%) had repeated ED visits before admission. Children admitted on initial visit and those with repeated visits had similar median lengths of stay (13 versus 12 days), critical care use (21.1% versus 16.7%), and mortality (mean 2.9%). One in 3 children repeating visits returned to a different hospital. Repeated visits were associated with older age, a less acute triage score, and initial visit to a community hospital without available pediatric consultation.
  
  
  CONCLUSIONS
  In this cohort, repeated ED visits among children with meningitis or septicemia were common, yet they had health outcomes similar to those of children admitted on initial visit. One in 3 returned to a different ED, making it unlikely that EDs and clinicians can learn from these critical events without a regionalized reporting system.
authors.affiliation: Department of Emergency Medicine and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: Sam.Vaillancourt@utoronto.ca.
authors.forename: Samuel
authors.initials: S
authors.lastname: Vaillancourt
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Paediatric Medicine, Hospital for Sick Children and the Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Ian Y M
authors.initials: IY
authors.lastname: Chan
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Vermeulen
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000401:mortality; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis*; D013997:Time Factors