Unplanned reattendance of pediatric patients with fever at emergency department

Abstract

Fever is one of the most common presenting complaints to Accident and Emergency departments (AED) in children. Although most fevers in children are caused by self-limiting viral illnesses, which can be treated and discharged from AED, there is a significant number of reattendance due to various patient-related, illness-related, and system-related factors. However, there is no consensus on the definition of reattendance, and lack of sufficient evidence on the risk factors of pediatric fever-related reattendance in AED, as well as the subsequent hospitalization. Therefore, this thesis aims to (1) conduct a review to summarize the current knowledge on pediatric reattendance in AED; (2) identify determinants of fever-related reattendance in AED; (3) examine patient-, illness- and system-related factors associated with fever-related reattendance in AED; (4) identify determinants of hospitalization of fever-related reattendance in AED, and (5) examine patient-, illness- and system-related factors associated with hospitalization of fever-related reattendees admitted to AED. A scoping review of the definition and characteristics of pediatric fever-related reattendance in AED and the subsequent hospitalization was conducted. Next, I conducted a retrospective, cross-sectional, descriptive study with data collected from a local AED with 1968 cases. Firstly, the comparison was made between the reattendance group and non-reattendance group. Independent variables including patient characteristics, complaints, triage information, consultation, diagnosis, discharge process and healthcare professional were examined on the fever-related reattendance. Secondly, the comparison was made between the determinants of the reattendance group in terms of discharge and admission with the same independent variables to examine the context of associated factors contributing to hospitalization on reattendance. In the scoping review, inconclusive results in the reattendance definition and rate were found. For fever-related reattendance, only one study recognized poor economic status as a patient-related factor, as well as presence of chronic disease and higher severity triage scores as illness-related factors. No system-related factors were identified. From my retrospective study, young age as patient-related factor; chronic disease and vomiting in chief complaints as illness-related factors; mean waiting time and discharged with referral as system-related factors were found associated with fever-related reattendance. For the factors associated with fever-related hospitalization on reattendance, there were significant positive association with illness-related factors, such as decreased intake, vomiting, fever duration, temperature at triage, triage category, X-ray as investigation, Paracetamol as treatment, fever-related and lower respiratory tract infection. There were significant negative association on patient-related factors such as age, the recipient of social security assistance and living in public housing, illness-related factors such as urine test, tepid sponge, upper respiratory tract infection and ear, nose, and throat related illness. The study also discovered the phenomena of insufficient discharge instructions and the possibility of unnecessary reattendance of patients with social security assistance.

In conclusion, this thesis reviewed the common situation of pediatrics fever-related reattendance and hospitalization. It also provides research, practice, and policy implications for the future. This thesis offered a new concept to the situation of fever-related pediatrics reattendance in AED and would eventually lower the unnecessary reattendance rate.