• Chih-Wei Sung, Tsung-Chien Lu, Cheng-Chung Fang, Jia-You Lin, Huang-Fu Yeh, Chien-Hua Huang, and Chu-Lin Tsai.
• Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.
• Eur J Emerg Med. 2021 Oct 1; 28 (5): 394401394-401.

Background And ImportanceAlthough factors related to a return emergency department (ED) visit have been reported, few studies have examined 'high-risk' return ED visits with serious adverse outcomes. Understanding factors associated with high-risk return ED visits may help with early recognition and prevention of these catastrophic events.ObjectivesWe aimed to (1) estimate the incidence of high-risk return ED visits, and (2) to investigate time-varying factors associated with these revisits.DesignCase-crossover study.Settings And ParticipantsWe used electronic clinical warehouse data from a tertiary medical center. We retrieved data from 651 815 ED visits over a 6-year period. Patient demographics and computerized triage information were extracted.Outcome Measure And AnalysisA high-risk return ED visit was defined as a revisit within 72 h of the index visit with ICU admission, receiving emergency surgery, or with in-hospital cardiac arrest during the return ED visit. Time-varying factors associated with a return visit were identified.Main ResultsThere were 440 281 adult index visits, of which 19 675 (4.5%) return visits occurred within 72 h. Of them, 417 (0.1%) were high-risk revisits. Multivariable analysis showed that time-varying factors associated with an increased risk of high-risk revisits included the following: arrival by ambulance, dyspnea, or chest pain on ED presentation, triage level 1 or 2, acute change in levels of consciousness, tachycardia (>90/min), and high fever (>39°C).ConclusionsWe found a relatively small fraction of discharges (0.1%) developed serious adverse events during the return ED visits. We identified symptom-based and vital sign-based warning signs that may be used for patient self-monitoring at home, as well as new-onset signs during the return visit to alert healthcare providers for timely management of these high-risk revisits.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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