title: Unscheduled return visits to a pediatric emergency department.
abstract: OBJECTIVE
  Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania.
  
  
  METHODS
  A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n=44097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression.
  
  
  RESULTS
  Of the overall ED population, 33889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72h, giving a RV rate of 3.0%. Being a 0-7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01a.m. to 4:00p.m. and underwent radiological test were less likely to return to the ED within 72h. Diseases such as gastrointestinal disorders or respiratory tract/earth-nose-throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%).
  
  
  CONCLUSIONS
  RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.
authors.affiliation: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania. Electronic address: sigita.burokiene@vuvl.lt.
authors.forename: Sigita
authors.initials: S
authors.lastname: Burokienė
authors.affiliation: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania.
authors.forename: Ignė
authors.initials: I
authors.lastname: Kairienė
authors.affiliation: Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Marius
authors.initials: M
authors.lastname: Strička
authors.affiliation: Department of Children Diseases, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Liutauras
authors.initials: L
authors.lastname: Labanauskas
authors.affiliation: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania.
authors.forename: Rimantė
authors.initials: R
authors.lastname: Čerkauskienė
authors.affiliation: Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Lithuania.
authors.forename: Juozas
authors.initials: J
authors.lastname: Raistenskis
authors.affiliation: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania.
authors.forename: Emilija
authors.initials: E
authors.lastname: Burokaitė
authors.affiliation: Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Lithuania.
authors.forename: Vytautas
authors.initials: V
authors.lastname: Usonis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008097:Lithuania; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
keywords: Children; Overcrowding; Pediatric emergency department; Return visit; Urgent care