Cargando…

Risk Factors for Emergency Department Unscheduled Return Visits

Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study in...

Descripción completa

Detalles Bibliográficos
Autores principales: Soh, Crystal Harn Wei, Lin, Ziwei, Pan, Darius Shaw Teng, Ho, Weng Hoe, Mahadevan, Malcolm, Chua, Mui Teng, Kuan, Win Sen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723936/
https://www.ncbi.nlm.nih.gov/pubmed/31405058
http://dx.doi.org/10.3390/medicina55080457
_version_ 1783448886719807488
author Soh, Crystal Harn Wei
Lin, Ziwei
Pan, Darius Shaw Teng
Ho, Weng Hoe
Mahadevan, Malcolm
Chua, Mui Teng
Kuan, Win Sen
author_facet Soh, Crystal Harn Wei
Lin, Ziwei
Pan, Darius Shaw Teng
Ho, Weng Hoe
Mahadevan, Malcolm
Chua, Mui Teng
Kuan, Win Sen
author_sort Soh, Crystal Harn Wei
collection PubMed
description Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.
format Online
Article
Text
id pubmed-6723936
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-67239362019-09-10 Risk Factors for Emergency Department Unscheduled Return Visits Soh, Crystal Harn Wei Lin, Ziwei Pan, Darius Shaw Teng Ho, Weng Hoe Mahadevan, Malcolm Chua, Mui Teng Kuan, Win Sen Medicina (Kaunas) Article Background and Objectives: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. Materials and Methods: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Results: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12–4.23), fever (1.60; 1.1–2.33), neurological deficit (4.26; 1.94–9.35), and discharge without follow-up (1.61; 1.1–2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29–3.31), asthma (5.23; 1.59–17.26), and renal disease (7.48; 2.00–28.05); presenting complaints of abdominal pain (1.83; 1.32–2.55), fever (3.05; 2.10–4.44), and giddiness or vertigo (2.17; 1.26–3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs. MDPI 2019-08-09 /pmc/articles/PMC6723936/ /pubmed/31405058 http://dx.doi.org/10.3390/medicina55080457 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Soh, Crystal Harn Wei
Lin, Ziwei
Pan, Darius Shaw Teng
Ho, Weng Hoe
Mahadevan, Malcolm
Chua, Mui Teng
Kuan, Win Sen
Risk Factors for Emergency Department Unscheduled Return Visits
title Risk Factors for Emergency Department Unscheduled Return Visits
title_full Risk Factors for Emergency Department Unscheduled Return Visits
title_fullStr Risk Factors for Emergency Department Unscheduled Return Visits
title_full_unstemmed Risk Factors for Emergency Department Unscheduled Return Visits
title_short Risk Factors for Emergency Department Unscheduled Return Visits
title_sort risk factors for emergency department unscheduled return visits
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723936/
https://www.ncbi.nlm.nih.gov/pubmed/31405058
http://dx.doi.org/10.3390/medicina55080457
work_keys_str_mv AT sohcrystalharnwei riskfactorsforemergencydepartmentunscheduledreturnvisits
AT linziwei riskfactorsforemergencydepartmentunscheduledreturnvisits
AT pandariusshawteng riskfactorsforemergencydepartmentunscheduledreturnvisits
AT howenghoe riskfactorsforemergencydepartmentunscheduledreturnvisits
AT mahadevanmalcolm riskfactorsforemergencydepartmentunscheduledreturnvisits
AT chuamuiteng riskfactorsforemergencydepartmentunscheduledreturnvisits
AT kuanwinsen riskfactorsforemergencydepartmentunscheduledreturnvisits