Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain
Abstract Background Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality. Objective We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-023-01256-7 |
| _version_ | 1797577320670691328 |
|---|---|
| author | Li-Tsung Lin Sheng-Feng Lin Chun-Chieh Chao Hui-An Lin |
| author_facet | Li-Tsung Lin Sheng-Feng Lin Chun-Chieh Chao Hui-An Lin |
| author_sort | Li-Tsung Lin |
| collection | DOAJ |
| description | Abstract Background Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality. Objective We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission (URVAs) from URVs without admission (URVNAs). Methods This retrospective study included adult patients who visited the ED of Taipei Medical University Hospital because of abdominal pain and revisited in 72 h over a 5-year period (January 1, 2014, to December 31, 2018). Multivariable logistic regression analysis was employed to identify risk factors for URVAs and receiver operating characteristic (ROC) curve analysis was performed to determine the efficacy of variables predicting URVAs and the optimal cut-off points for the variables. In addition, a classification and regression tree (CART)-based scoring system was used for predicting risk of URVA. Results Of 702 eligible patients with URVs related to abdominal pain, 249 had URVAs (35.5%). In multivariable analysis, risk factors for URVAs during the index visit included execution of laboratory tests (yes vs no: adjusted odds ratio [AOR], 4.32; 95% CI 2.99–6.23), older age (≥ 40 vs < 40 years: AOR, 2.10; 95% CI 1.10–1.34), Level 1–2 triage scores (Levels 1–2 vs Levels 3–5: AOR, 2.30; 95% CI 1.26–4.19), and use of ≥ 2 analgesics (≥ 2 vs < 2: AOR, 2.90; 95% CI 1.58–5.30). ROC curve analysis results revealed the combination of these 4 above variables resulted in acceptable performance (area under curve: 0.716). The above 4 variables were used in the CART model to evaluate URVA propensity. Conclusions Elder patients with abdominal pain who needed laboratory workup, had Level 1–2 triage scores, and received ≥ 2 doses of analgesics during their index visits to the ED had higher risk of URVAs. |
| first_indexed | 2024-03-10T22:06:36Z |
| format | Article |
| id | doaj.art-a76a3d74f7224b999f26397d462b542b |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-10T22:06:36Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-a76a3d74f7224b999f26397d462b542b2023-11-19T12:46:54ZengBMCEuropean Journal of Medical Research2047-783X2023-08-0128111110.1186/s40001-023-01256-7Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal painLi-Tsung Lin0Sheng-Feng Lin1Chun-Chieh Chao2Hui-An Lin3School of Medicine, College of Medicine, Taipei Medical UniversityDepartment of Public Health, School of Medicine, College of Medicine, Taipei Medical UniversityDepartment of Emergency Medicine, Taipei Medical University HospitalDepartment of Emergency Medicine, Taipei Medical University HospitalAbstract Background Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality. Objective We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission (URVAs) from URVs without admission (URVNAs). Methods This retrospective study included adult patients who visited the ED of Taipei Medical University Hospital because of abdominal pain and revisited in 72 h over a 5-year period (January 1, 2014, to December 31, 2018). Multivariable logistic regression analysis was employed to identify risk factors for URVAs and receiver operating characteristic (ROC) curve analysis was performed to determine the efficacy of variables predicting URVAs and the optimal cut-off points for the variables. In addition, a classification and regression tree (CART)-based scoring system was used for predicting risk of URVA. Results Of 702 eligible patients with URVs related to abdominal pain, 249 had URVAs (35.5%). In multivariable analysis, risk factors for URVAs during the index visit included execution of laboratory tests (yes vs no: adjusted odds ratio [AOR], 4.32; 95% CI 2.99–6.23), older age (≥ 40 vs < 40 years: AOR, 2.10; 95% CI 1.10–1.34), Level 1–2 triage scores (Levels 1–2 vs Levels 3–5: AOR, 2.30; 95% CI 1.26–4.19), and use of ≥ 2 analgesics (≥ 2 vs < 2: AOR, 2.90; 95% CI 1.58–5.30). ROC curve analysis results revealed the combination of these 4 above variables resulted in acceptable performance (area under curve: 0.716). The above 4 variables were used in the CART model to evaluate URVA propensity. Conclusions Elder patients with abdominal pain who needed laboratory workup, had Level 1–2 triage scores, and received ≥ 2 doses of analgesics during their index visits to the ED had higher risk of URVAs.https://doi.org/10.1186/s40001-023-01256-7Abdominal painEmergency departmentReturn visit |
| spellingShingle | Li-Tsung Lin Sheng-Feng Lin Chun-Chieh Chao Hui-An Lin Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain European Journal of Medical Research Abdominal pain Emergency department Return visit |
| title | Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| title_full | Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| title_fullStr | Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| title_full_unstemmed | Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| title_short | Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| title_sort | predictors of 72 h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain |
| topic | Abdominal pain Emergency department Return visit |
| url | https://doi.org/10.1186/s40001-023-01256-7 |
| work_keys_str_mv | AT litsunglin predictorsof72hunscheduledreturnvisitswithadmissioninpatientspresentingtotheemergencydepartmentwithabdominalpain AT shengfenglin predictorsof72hunscheduledreturnvisitswithadmissioninpatientspresentingtotheemergencydepartmentwithabdominalpain AT chunchiehchao predictorsof72hunscheduledreturnvisitswithadmissioninpatientspresentingtotheemergencydepartmentwithabdominalpain AT huianlin predictorsof72hunscheduledreturnvisitswithadmissioninpatientspresentingtotheemergencydepartmentwithabdominalpain |