LAKE BUENA VISTA, FLA. – Fever or lack of an antibiotic prescription are two factors that increase the risk of a return visit to the emergency department and subsequent hospital admission in children with community-acquired pneumonia, according to a review of ED medical records.
Of 1,857 children aged 3 months to 18 years with a diagnosis of pneumonia who were discharged to home after the index ED visit between November 2009 and April 2013, 131 (7.1%) returned to the ED within 7 days, 90 of those (4.8%) were discharged to home, and 41 (2.2%) were admitted, Dr. Emily Fain of Cincinnati Children’s Hospital reported in a poster at the Pediatric Hospital Medicine 2014 meeting.
Factors shown on multivariable analyses to be significantly associated with a return visit were tachycardia at discharge (odds ratio, 1.48), fever at discharge (OR, 1.89 for a temperature of 99.5-101.2° F, and 2.35 for a temperature greater than 101.3° F, compared with a temperature less than 99.5° F), and lack of an antibiotic prescription (OR, 0.44 among those who received a prescription).
Factors associated with admission at the time of the ED revisit were tachypnea in the ED (OR, 2.01), fever at discharge (OR, 3.48 for a temperature of 99.5-101.2° F, and 4.51 for a temperature greater than 101.3° F, compared with a temperature less than 99.5° F), history of community-acquired pneumonia (CAP) (OR, 3.98), lack of an antibiotic prescription (OR, 0.32 for those who received a prescription), time of visit (OR, 0.43 for those who arrived between 4 p.m. and 12 a.m., compared with arrival between 8 a.m. and 4 p.m.), and race (OR, 0.44 for African Americans vs. whites).
Revisits to the ED are an indicator of quality of care and disease progression, and CAP is among the most common reasons for ED visits, the investigators noted at the meeting sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, the AAP Section on Hospital Medicine, and the Academic Pediatric Association.
"Attention to these risk factors, particularly potentially modifiable factors such as vital signs, could influence decision making when treating patients for CAP. Further investigation is warranted to better understand the association between lack of antibiotic prescription and revisit to the ED with and without subsequent hospitalization," they concluded.
This study was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health. Dr. Fain and her colleagues reported having no disclosures.