Risk Factors Associated With Emergency Department Revisits and Subsequent Hospitalizations in Previously Healthy Children Treated for Croup.

Background and objective: It is unclear which children are more likely to return to the emergency department (ED) after an ED discharge for croup. We investigated patient-related and care-related factors associated with increased odds of ED revisits and subsequent hospitalizations within 3 days of ED discharge after treatment of croup.

Methods: This retrospective multicentered cohort study used the Pediatric Health Information System database. Previously healthy patients aged 6 months to 6 years who presented to pediatric EDs between January 2016 and December 2022 with a primary diagnosis of croup were included. Characteristics of the ED revisit and nonrevisit groups were compared, and multivariable mixed-effects logistic regression analyses were used to evaluate ED revisit within 3 days of discharge and hospital admission after an ED revisit.

Results: Of 270 919 unique patients with croup seen and discharged from the ED, 12 470 (4.6%) revisited the ED within 3 days of discharge and 1949 (15.6%) of those who revisited the ED required subsequent hospital admission. Specific patient- and care-related factors were associated with higher odds of ED revisits and need for subsequent admission. Patients who were younger, boys, received racemic epinephrine and/or steroids, received antipyretics or bronchodilators, had chest and/or neck imaging, had electrolyte testing, or presented during the daytime had higher odds of revisiting the ED and requiring subsequent admission.

Conclusion: This study suggests consideration of additional risk factors such as age, sex, initial ED treatments, tests, and imaging received when providing appropriate anticipatory guidance and discharge planning for children evaluated in EDs for croup.