Prognostic Factors Associated With Unplanned Return Emergency Department Visits in the United States: Systematic Review.

Abstract

Abstract: Unplanned return emergency department (ED) visits (RV) and return ED visits leading to admission (RVA) are common. A comprehensive assessment of prognostic factors associated with RVs and RVAs is required to guide further inquiry into how they might be mitigated. We conducted a prognostic indicator systematic review of factors associated with an emergency department (ED) return visit (RV) and RV with admission (RVA) within 30 days of the index ED visit using PRIMSA guidelines (PROSPERO #CRD42023483802). After searching Medline, EMBASE, CINAHL, and Cochrane Library, two investigators independently screened titles/abstracts, extracted data, and assessed risks of bias using the QUIPS template. In total, six studies were included. Most studies were hampered by risks of bias from study participation and study attrition. We found wide variation in the inclusion or exclusion of patient phenotypes associated with frequent ED utilization in the denominator of patients at risk for RV and RVA. Ultimately, heterogeneity and risk of bias precluded meta-analyses. We tabulated ranges of odds ratios for multiple subject-level, ED-level, and hospital-level prognostic factors. Male patient sex, Medicaid or Medicare insurance, and lower acuity emergency severity index scores were most consistently associated with higher risks of RV and RVA within 30 days.