Abstract
BACKGROUND: Acute respiratory infections (ARI) are among the leading causes of pediatric emergency department (ED) visits. The rate of unplanned returns to pediatric ED is an important quality indicator, and it is associated with factors such as age and clinical complexity. This study aims to identify the determinants associated with the risk of return to the ED, for any cause, within 7 days of discharge home with a diagnosis of ARI. METHODS: A retrospective cohort study was conducted in a tertiary care children's hospital in Italy, including all ED visits with a primary diagnosis of ARI and discharge to home between July 1, 2021, and June 30, 2023. The study aimed to estimate the risk of return to ED in terms of variables related to the access, patient characteristics, and pharmacologic treatment, by fitting a multivariate multilevel logistic regression model. RESULTS: During the study period, 2987 returns to the ED occurred within 7 days of discharge, representing 8.8% of the 33,933 ARI-related ED visits with discharge to home. Multivariate analysis revealed several statistically significant predictive factors, including triage code, age, diagnosis of acute bronchiolitis, absence of symptoms on arrival, prescription of systemic antibacterials in the ED, and presence of a secondary diagnosis. CONCLUSIONS: Readmissions to the ED for pediatric ARI in the postpandemic period have a multifactorial nature. Contributing factors range from the initial severity of the clinical condition to the specific characteristics of the patients. Recognizing and understanding these determinants offers an opportunity to develop targeted interventions aimed at optimizing the discharge process.