Abstract
Objectives
The primary aim of this study was to evaluate for differences in acuity level and
rate of admission on return visit between patients who leave without being seen (LWBS)
and those who are initially evaluated by a physician. Our secondary aim was as well
as to identify predictors of which LWBS patients will return to the ED with high acuity
or require admission.
Methods
A cross-sectional study using an administrative database at an academic tertiary-care
pediatric hospital in the United States from January 1, 2006, to December 31, 2008
was done.
Results
There were 3525 patients who LWBS during the study period (1.2% of total ED visits).
Of these, 87% were triaged as nonurgent, and 13% as urgent at their initial visit.
Two hundred eighty-nine (8%) of LWBS patients returned to the ED within 48 hours.
Compared with the population who returned to the ED after previous evaluation, patients
who LWBS from their initial visit and returned had significantly lower odds of urgent
acuity at time of return visit (odds ratio [OR], 0.22; 95% confidence interval [CI],
0.15-0.32) and of being admitted (OR, 0.58; 95% CI, 0.40-0.84). Urgent acuity at initial
visit (OR, 2.86; 95% CI, 1.35-6.04) and number of ED visits in last 6 months (OR,
1.24; 95% CI, 1.02-1.52) were significant predictors of admission at return visit
among the LWBS population.
Conclusions
Generally, patients who LWBS from a pediatric ED were unlikely to return for ED care,
and those who did were unlikely to either be triaged as urgent or require hospital
admission. This study showed that urgent acuity during the initial visit and number
of previous ED visits were significant predictors of admission on return. Identification
of these predictors may allow a targeted intervention to ensure follow-up of patients
who meet these criteria after they LWBS from the pediatric ED.
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Article Info
Publication History
Published online: October 26, 2011
Accepted:
June 18,
2011
Received in revised form:
June 17,
2011
Received:
May 9,
2011
Footnotes
☆Poster presentation: Poster presentation at the Pediatric Academic Societies Conference, Vancouver, May 2010.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
