Repeated Emergency Department Visits Among Children Admitted With Meningitis or Septicemia: A Population-Based Study

• Published in: Annals of emergency medicine 2015-06, Vol.65 (6), p.625-632.e3
• Main Authors: Vaillancourt, Samuel, MDCM, MPH, Guttmann, Astrid, MDCM, MSc, Li, Qi, MSc, Chan, Ian Y.M., BHSc, MPH, Vermeulen, Marian J., MHSc, Schull, Michael J., MD, MSc
• Format: Article
• Language: English
• Subjects: Age Factors; Child; Child, Preschool; Diagnostic Errors - statistics & numerical data; Emergency; Emergency Service, Hospital - utilization; Hospitalization - statistics & numerical data; Humans; Infant; Length of Stay - statistics & numerical data; Male; Meningitis - diagnosis; Meningitis - mortality; Ontario - epidemiology; Retrospective Studies; Sepsis - diagnosis; Time Factors
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2014.10.022

Study 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. Conclusion 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.