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Open Access Publications from the University of California

High-Risk Return Visits to United States Emergency Departments, 2010–2018


Objectives: Although factors related to a return visit to the emergency department (ED) have been reported, only few studies have examined “high-risk” ED revisits with serious adverse outcomes. This study aimed to describe the incidence and trend of high-risk ED revisits in United States EDs and to investigate factors associated with these revisits.

Methods: Data were obtained from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 20102018. Adult ED revisits within 72 hours of a previous discharge were identified using a mark on the Patient Record Form. High-risk revisits were defined as revisits with serious adverse outcomes, including intensive care unit admissions, emergency surgery, cardiac catheterization, or cardiopulmonary resuscitation (CPR) during the return visit. Analyses used descriptive statistics and multivariable logistic regression accounting for NHAMCS's complex survey design.

Results: Over the 9-year study period, there were an estimated 37,700,000 revisits, and the proportion of revisits in the entire ED population decreased slightly from 5.1% in 2010 to 4.5% in 2018 (P for trend = 0.02). By contrast, there were an estimated 827,000 high-risk ED revisits, and the proportion of high-risk revisits in the entire ED population remained stable at approximately 0.1%. The mean age of these high-risk revisit patients was 57 years, and 43% were men. Approximately 6% of the patients were intubated, and 13% received CPR. Most of them were hospitalized, and 2% died in the ED. Multivariable analysis showed older age (65+ years), Hispanic ethnicity, daytime visits, and arrival by ambulance during the revisit were independent predictors of high-risk revisits.

Conclusions: High-risk revisits accounted for a relatively small fraction (0.1%) of the ED visits. Over the time period of NHAMCS survey between 2010-2018, this fraction remained stable. We identified factors during the return visit that could be used to label high-risk revisits for timely intervention.

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