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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2023

Open Access 01-12-2023 | Key Symptom | Research

Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain

Authors: Li-Tsung Lin, Sheng-Feng Lin, Chun-Chieh Chao, Hui-An Lin

Published in: European Journal of Medical Research | Issue 1/2023

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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.
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Literature
1.
Abualenain J, et al. The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department. J Emerg Med. 2013;45(2):281–8.PubMedCrossRef
2.
3.
Jimenez-Puente A, et al. Causes of 72-hour return visits to hospital emergency departments. Emergencias: Revista de la Sociedad Espanola de Medicina de Emergencias. 2015;27(5):287–93.PubMed
4.
Liaw SJ, et al. Rates and causes of emergency department revisits within 72 hours. J Formos Med Assoc Taiwan yi zhi. 1999;98(6):422–5.PubMed
5.
Wu C-L, et al. Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan. J Emerg Med. 2010;38(4):512–7.PubMedCrossRef
6.
Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med. 2000;160(8):1074–81.PubMedCrossRef
7.
Frankl SE, Breeling JL, Goldman L. Preventability of emergent hospital readmission. Am J Med. 1991;90(6):667–74.PubMedCrossRef
8.
Pham JC, et al. Seventy-two-hour returns may not be a good indicator of safety in the emergency department: a national study. Acad Emerg Med. 2011;18(4):390–7.PubMedCrossRef
9.
Lindsay P, et al. The development of indicators to measure the quality of clinical care in emergency departments following a modified-Delphi approach. Acad Emerg Med. 2002;9(11):1131–9.PubMed
10.
Hu K-W, et al. Unscheduled return visits with and without admission post emergency department discharge. J Emerg Med. 2012;43(6):1110–8.PubMedCrossRef
11.
Meltzer AC, et al. US emergency department visits for adults with abdominal and pelvic pain (2007–13): trends in demographics, resource utilization and medication usage. Am J Emerg Med. 2017;35(12):1966–9.PubMedCrossRef
12.
Hastings RS, Powers RD. Abdominal pain in the ED: a 35 year retrospective. Am J Emerg Med. 2011;29(7):711–6.PubMedCrossRef
13.
Toorenvliet BR, et al. Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. World J Surg. 2010;34(3):480–6.PubMedPubMedCentralCrossRef
14.
Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13(3):301–3.PubMedCrossRef
15.
Kamin RA, et al. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin. 2003;21(1):61–72.CrossRef
16.
Fagerström A, et al. Non-specific abdominal pain remains as the most common reason for acute abdomen: 26-year retrospective audit in one emergency unit. Scand J Gastroenterol. 2017;52(10):1072–7.PubMedCrossRef
17.
18.
Medford-Davis L, et al. Diagnostic errors related to acute abdominal pain in the emergency department. Emerg Med J. 2016;33(4):253–9.PubMedCrossRef
19.
Liu S-W. Risk factors of admission in 72-h return visits to emergency department. Tzu-Chi Med J. 2021;33(2):169.PubMedCrossRef
20.
Ng C-J, et al. Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system. Emerg Med J. 2011;28(12):1026–31.PubMedCrossRef
21.
Parker J, Vukov L, Wollan P. Abdominal pain in the elderly: use of temperature and laboratory testing to screen for surgical disease. Fam Med. 1996;28(3):193–7.PubMed
22.
Panebianco NL, Jahnes K, Mills AM. Imaging and laboratory testing in acute abdominal pain. Emerg Med Clin. 2011;29(2):175–93.CrossRef
23.
Natesan S, et al. Evidence-based medicine approach to abdominal pain. Emerg Med Clin. 2016;34(2):165–90.CrossRef
24.
Lewis Hunter AE, et al. Factors influencing hospital admission of non-critically ill patients presenting to the emergency department: a cross-sectional study. J Gen Intern Med. 2016;31(1):37–44.PubMedCrossRef
25.
Pines JM. Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain. Med Care. 2009;47(7):782–6.PubMedCrossRef
26.
Fenyö G. Acute abdominal disease in the elderly: experience from two series in Stockholm. Am Jf Surg. 1982;143(6):751–4.CrossRef
27.
Fenyö G. Diagnostic problems of acute abdominal diseases in the aged. Acta Chir Scand. 1974;140:396.PubMed
28.
Cooper GS, Shlaes DM, Salata RA. Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly. Clin Infect Dis. 1994;19(1):146–8.PubMedCrossRef
29.
Hastings SN, et al. Adverse health outcomes after discharge from the emergency department—incidence and risk factors in a veteran population. J Gen Intern Med. 2007;22(11):1527–31.PubMedPubMedCentralCrossRef
30.
Ginsburg AD, et al. Should age be incorporated into the adult triage algorithm in the emergency department? Am J Emerg Med. 2021;46:508–14.PubMedCrossRef
31.
Kizer KW, Vassar MJ. Emergency department diagnosis of abdominal disorders in the elderly. Am J Emerg Med. 1998;16(4):357–62.PubMedCrossRef
32.
Martin-Gill C, Reiser RC. Risk factors for 72-hour admission to the ED. Am J Emerg Med. 2004;22(6):448–53.PubMedCrossRef
33.
Chan AHS, et al. Characteristics of patients who made a return visit within 72 hours to the emergency department of a Singapore tertiary hospital. Singap Med J. 2016;57(6):301.CrossRef
34.
Wang H-Y, et al. The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours. Chang Gung Med J. 2007;30(5):437.PubMed
35.
Gabayan GZ, et al. Factors associated with short-term bounce-back admissions after emergency department discharge. Ann Emerg Med. 2013;62(2):136-144 e1.PubMedPubMedCentralCrossRef
36.
Fan JS, et al. Risk factors and prognostic predictors of unexpected intensive care unit admission within 3 days after ED discharge. Am J Emerg Med. 2007;25(9):1009–14.PubMedCrossRef
37.
Sung C-W, et al. Factors associated with a high-risk return visit to the emergency department: a case-crossover study. Eur J Emerg Med. 2021;28(5):394–401.PubMedCrossRef
38.
Oh BY, Kim K. Factors associated with the undertriage of patients with abdominal pain in an emergency room. Int Emerg Nurs. 2021;54:100933.PubMedCrossRef
39.
Gordon DB. Acute pain assessment tools: let us move beyond simple pain ratings. Curr Opin Anesthesiol. 2015;28(5):565–9.CrossRef
40.
Gordon DB, et al. American pain society recommendations for improving the quality of acute and cancer pain management: American pain society quality of care task force. Arch Intern Med. 2005;165(14):1574–80.PubMedCrossRef
41.
Tompkins DA, Hobelmann JG, Compton P. Providing chronic pain management in the “Fifth Vital Sign” Era: historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Depend. 2017;173:S11–21.PubMedPubMedCentralCrossRef
42.
43.
44.
Hernandez-Boussard T, et al. The fifth vital sign postoperative pain predicts 30-day readmissions and subsequent emergency department visits. Ann Surg. 2017;266(3):516.PubMedCrossRef
45.
Solodiuk JC, Curley MA. In defense of routine inpatient pain assessment. AJN Am J Nurs. 2017;117(5):11.CrossRef
46.
Ahluwalia SC, et al. “It encourages them to complain”: a qualitative study of the unintended consequences of assessing patient-reported pain. J Pain. 2018;19(5):562–8.PubMedCrossRef
47.
Oguzturk H, et al. Tramadol or paracetamol do not effect the diagnostic accuracy of acute abdominal pain with significant pain relief-a prospective, randomized, placebo controlled double blind study. Eur Rev Med Pharmacol Sci. 2012;16(14):1983–8.PubMed
48.
Thomas S, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. J Br Surg. 2003;90(1):5–9.CrossRef
Metadata
Title
Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain
Authors
Li-Tsung Lin
Sheng-Feng Lin
Chun-Chieh Chao
Hui-An Lin
Publication date
01-12-2023
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2023
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-023-01256-7

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