Factors Associated with Unscheduled Emergency Department Revisits in Children with Acute Lower Respiratory Tract Diseases

Figures & data

Table 1 Baseline Characteristics of the Children

Characteristics	Total Visits	Non-Revisit	Revisit	P-value
	N = 1417	N = 870	N = 70
Median age (y), (IQR)	3.04 (1.52, 5.24)	3.3 (1.7, 5.8)	3.3 (1.7, 5.5)	0.973
Age group, n (%)				0.623
Infant (1–12 mo.)	202 (14.3)	104 (12)	6 (8.6)
Toddler (1–2 y)	367 (25.9)	207 (23.8)	19 (27.1)
Preschool age (3–5 y)	508 (35.9)	321 (36.9)	25 (35.7)
School age (6–11 y)	273 (19.2)	186 (21.4)	18 (25.7)
Adolescent (12–15 y)	67 (4.7)	52 (6)	2 (2.9)
Gender, male, n (%)	896 (63.2%)	553 (63.6)	47 (67.1)	0.638
History of preterm birth, n (%)	41 (2.9)	15 (1.7)	4 (5.7)	0.047
History of intubation, n (%)	7 (0.5)	4 (0.5)	0	0.999
Asthma or current controller use, n (%)	497 (35.1)	305 (35.1)	43 (61.4)	< 0.001
ESI, n (%)				0.571
1	2 (0.2)	2 (0.2)	0 (0)
2	1243 (87.7)	744 (85.5)	65 (92.9)
3	122 (8.6)	78 (9)	4 (5.7)
4	44 (3.1)	40 (4.6)	1 (1.4)
5	6 (0.4)	6 (0.7)	0 (0)

Abbreviations: ESI, Emergency Severity Index; IQR, interquartile range.

Table 2 Comparison of Children’s Vital Signs, Investigations, and Treatment

Characteristics	Non-Revisit	Revisit	P-value
	N = 870	N = 70
Initial vital signs
BT (°C), median (IQR)	37.1 (36.7, 37.7)	37.1 (36.7, 37.5)	0.513
SpO2 (%), median (IQR)	97 (95, 99)	97 (96, 98)	0.349
Pulse, abnormal, n (%)	565 (65.5)	39 (57.4)	0.223
RR, abnormal, n (%)	619 (74.5)	45 (70.3)	0.557
Pulse pressure, abnormal, n (%)	149 (18.6)	12 (20)	0.916
Final vital signs
BT (°C), median (IQR)	37.1 (36.7, 37.7)	37.1 (36.7, 37.5)	0.513
SpO2 (%), median (IQR)	98 (97, 100)	98 (97, 99)	0.4
Pulse, abnormal, n (%)	470 (61.4)	32 (59.3)	0.863
RR, abnormal, n (%)	325 (43.4)	24 (44.4)	0.993
Pulse pressure, abnormal, n (%)	97 (21)	3 (9.1)	0.916
Investigation
Influenza A/B, n (%)	11 (1.3)	0	0.712
RSV, n (%)	19 (2.2)	2 (2.9)	0.999
Diagnosis, n (%)			8.57
Bronchitis	380 (43.7)	27 (38.6)
Bronchiolitis	70 (8)	2 (2.9)
Pneumonia	128 (14.7)	9 (12.9)
Asthma	278 (32)	32 (45.7)
Others	14 (1.6)	0
Treatments
Numbers of nebulization, median (IQR)	2 (1, 3)	2 (1, 3)	0.941
Given steroids, n (%)	284 (32.6)	29 (41.4)	0.171
Oxygen supplementation, n (%)	19 (2.2)	2 (2.9)	0.666
IVF administration, n (%)	20 (2.3)	3 (4.3)	0.242
Oral antibiotics, n (%)	24 (2.8)	0	0.249
Primary doctor, n (%)			2.36
Intern	74 (8.5)	4 (5.7)
Resident 1	97 (11.1)	6 (8.6)
Resident 2	293 (33.7)	29 (41.4)
Resident 3	404 (46.4)	31 (44.3)
Attending physician	2 (0.2)	0
Consultation, n (%)	78 (9)	2 (2.9)	0.124
EDLOS (min.), median (IQR)	145 (91, 271)	113.5 (59.5, 171.5)	0.008

Abbreviations: BT, body temperature; SpO₂, oxygen saturation; RR, respiratory rate; RSV, respiratory syncytial virus; IVF administration, intravenous fluid administration; EDLOS, emergency department length of stay; IQR, interquartile range.

Table 3 Corticosteroids Use in Children with History of Asthma or Current Controller Use

Characteristic	Non-Revisit	Revisit	P-value
	N = 305	N = 43
Not prescribed steroids, n (%)	51 (16.7)	17 (39.5)	< 0.001
Not prescribed steroids at ED, n (%)	132 (52)	20 (76.9)	0.022
Time to steroids (min), median (IQR)	48 (28, 80)	76 (42.5, 100.5)	0.221
Time to steroids over 60 min., n (%)	43 (35.2)	3 (50)	0.666

Abbreviations: ED, emergency department; IQR, interquartile range.

Table 4 Comparison of Children’s Intervention Following Revisit

Characteristics	First Visit	Second Visit	P-value
	N= 70	N= 70
Numbers of nebulizations, median (IQR)	2 (1, 3)	2 (1, 3)	0.063
Oxygen supplementation, n (%)	2 (2.9)	24 (34.3)	< 0.001
IVF administration, n (%)	3 (4.3)	12 (17.1)	0.022
Consultation, n (%)	2 (2.9)	41 (58.6)	< 0.001

Abbreviations: IVF, intravenous fluid; IQR, interquartile range.