Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs

Abstract

Background: Vital signs (VS) are used to triage and identify children at risk for severe illness. Few studies have examined the association of pediatric VS at emergency department (ED) discharge with patient outcomes.

Objective: To determine if children discharged from the ED with abnormal VS have high rates of return visits, admission or adverse outcomes.

Methods: We conducted a retrospective cohort study of children discharged from 2 pediatric EDs with abnormal VS between July 2018-June 2019. We queried electronic health records (EHR) for children ages 0-18 years discharged from the ED with abnormal last recorded VS. VS were considered erroneously entered and thus excluded from analysis if heart rate was <30 or ≥ 300, respiratory rate was 0 or ≥ 100 or oxygen saturation was <50. Patients who were declared deceased at index visit were excluded. Demographic, clinical, and outcome data including return visits within 48 h and adverse outcomes after the initial ED discharge were obtained.

Results: Of the 97,824 children evaluated in the EDs during the study period, 17,661 (18.1%) were discharged with abnormal VS. 404 (2.28%) returned to the ED, of which 95 (23.5%) were admitted for the same chief complaint within 48 h. In comparison, the 48-h return rate for children discharged with normal VS was 2.45% (p = 0.219). Children discharged with abnormal VS were more likely to return if they had 2 or more abnormal VS (OR 1.6; 95% CI 1.23-2.07), were less than 3 years old (OR 1.69, 95% CI 1.39-2.06) or their initial acuity level was high (OR 1.34; 95% CI 1.1-1.63). Higher initial acuity level and age less than 3 years were also associated with admission at revisit (OR 2.58; 95% CI 1.59-4.2; OR 2.20, 95% CI 1.36-3.55). Four of the children who returned required PICU admission, but none died, required CPR or endotracheal intubation.

Conclusion: Although many children were discharged from the ED with abnormal VS, few returned and required admission. Having 2 or more abnormal VS, age less than 3 years and higher acuity increased odds of revisit. Few children suffered serious adverse outcomes.

Keywords: Pediatric emergency department; Return visits; Vital signs.