Disparities in Pediatric Emergency Department Revisits Within 7 Days by Disease Process.

Abstract

Objective: To identify disease processes in which patients experienced the greatest rates of emergency department (ED) revisit disparities by race, ethnicity, language, insurance, and Childhood Opportunity Index.

Methods: We performed a retrospective, cross-sectional study of ED visits at a comprehensive pediatric health system encompassing three EDs. We included all pediatric (0 to 18 y) ED encounters that led to a discharge home (2018 to 2022). The primary outcome was ED revisit within 7 days of the index encounter. We performed multivariable logistic regression to assess the relationship between diagnoses, patient demographics, and 7-day ED revisit.

Results: There were 1,008,651 total ED encounters included [53% (n = 529,960) were male]. Of all encounters, 52,176 (5.2%) had a 7-day ED revisit within the system. Patients who identified as black/African American (adjusted odds ratio [aOR]: 1.14, 95% CI: 1.11-1.17), multiracial (aOR: 1.14, 95% CI: 1.06-1.22), Hispanic (aOR: 1.21, 95% CI: 1.17-1.26), and those with public insurance (aOR: 1.19, 95% CI: 1.16-1.23) had greater odds of ED revisit. Disparities in ED revisits among Hispanic patients were concentrated in a few high-volume diagnoses, particularly within ear, nose, throat (ENT)/dental/mouth diseases (aOR: 1.11, 95% CI: 1.01-1.21) such as upper respiratory infections and infectious ear diseases. Conversely, disparities in ED revisits for black/African American patients were widespread across a broader range of diagnoses.

Conclusions: Disease-focused interventions are needed to reduce disparities in ED return visits. Focusing on upstream determinants of health may better reduce the burden of ED revisits for minoritized populations at risk of ED revisits.