title: Emergency Department Revisits by Urban Immigrant Children in Canada: A Population-Based Cohort Study.
abstract: OBJECTIVE
  To examine the relationship between family immigrant status and unscheduled 7-day revisits to the emergency department (ED) and to test this relationship within subgroups of immigrants by visa class (family, economic, refugee), native tongue on landing in Canada, and region of origin.
  
  
  METHODS
  Population-based cohort study that used multiple linked health administrative and demographic datasets of landed immigrant and nonimmigrant children (<18 years) in urban Ontario who visited an ED and were discharged between April 2003 and March 2010. Logistic regression was used to model the odds of 7-day ED revisits with family immigrant status, with adjustment for patient and ED characteristics.
  
  
  RESULTS
  Of 3,322,901 initial visits to the ED, 249,648 (7.5%) resulted in a 7-day revisit. There was no significant association of immigrant status with either ED revisits or poor revisit outcomes (greater acuity visit or need for admission) in the adjusted models. Within immigrants, the odds of revisit were not associated with immigrant classes or region of origin; however, immigrants whose native tongue was not English or French had a slightly greater odds of revisiting the ED (aOR 1.05; 95% CI 1.01, 1.09). Significant predictors of revisits included younger age, greater triage acuity score, greater predilection for using an ED, daytime shifts, and greater deprivation index.
  
  
  CONCLUSIONS
  Immigrant children are not more likely to have short-term revisits to the ED, but there may be barriers to care related to language fluency that need to be addressed. These findings may be relevant for improving translation services in EDs.
authors.affiliation: Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Natasha Ruth
authors.initials: NR
authors.lastname: Saunders
authors.affiliation: Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada; Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada; Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.affiliation: Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, The University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada; Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada. Electronic address: Astrid.guttmann@ices.on.ca.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007802:Language; D016015:Logistic Models; D008297:Male; D062072:Patient Acuity; D012189:Retrospective Studies; D012923:Social Class; D014505:Urban Population