Repeated Emergency Department Visits Among Children Admitted With Meningitis or Septicemia: A Population-Based Study - 24/05/15

Doi : 10.1016/j.annemergmed.2014.10.022

Samuel Vaillancourt, MDCM, MPH ^a,^⁎ , Astrid Guttmann, MDCM, MSc ^b,^c,^d, Qi Li, MSc ^b, Ian Y.M. Chan, BHSc, MPH ^b, Marian J. Vermeulen, MHSc ^b, Michael J. Schull, MD, MSc ^b,^d,^e,^f
^a Department of Emergency Medicine and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
^b Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
^c Division of Paediatric Medicine, Hospital for Sick Children and the Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
^d Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
^e Department of Medicine, University of Toronto, Toronto, Ontario, Canada
^f Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

^∗Corresponding Author.

Abstract

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.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

Study Design and Setting

Data Collection and Processing

Selection of Participants

Outcome Measures

Primary Data Analysis

Results

Characteristics of Study Subjects

Main Results

Limitations

Discussion

	Please see page 626 for the Editor’s Capsule Summary of this article.
	Supervising editors: Lise E. Nigrovic, MD, MPH; Steven M. Green, MD
	Author contributions: SV and MJS conceptualized the study and obtained research funding. SV, AG, and MJS were responsible for the data set creation plan. AG and MJV were responsible for the data analysis plan and provided methodological and statistical advice. QL and IYMC were responsible for the programming and statistical analysis. SV drafted the article, and all authors contributed substantially to the revisions and approved the final article. SV takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: This study was supported by a Canadian Association of Emergency Physicians Research Award. The Institute for Clinical Evaluative Sciences (ICES) is a nonprofit organization funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC), with provision of population-based data. Dr. Guttmann receives salary support from a Canadian Institute for Health Research Applied Chair in Child Health Services Research grant. Dr. Schull is supported by a CIHR Applied Chair in Health Services and Policy Research grant.
	The opinions, results, and conclusions reported in this article are those of the authors and are independent from all funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
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