Authors: Doctor Shagufta Kanwal , Doctor Zareen Qasmi , Doctor Irfan Habib

Abstract

INTRODUCTION

Unscheduled return visits (RVs) to Pediatric Emergency Departments within 72 hours of discharge remain a critical quality metric in Pediatric Emergency care.Numerous studies have highlighted a trend among caregivers to return to ED rather than consult primary care providers when a child’s symptoms persist or worsen, contributing to ED overcrowding, clinician fatigue, and diagnostic delays. Children returning within a short interval are typically assigned higher triage categories due to concerns about disease progression or missed diagnoses,necessitating specialist evaluation or inpatient admission. These return visits are also associated with increased clinical risks, including a higher chance of complications or mortality.

OBJECTIVE
 This study aims to investigate the clinical characteristics,revisit patterns,and outcomes of pediatric patients who return to the emergency department within 72 hours of discharge

METHODOLOGY
A retrospective chart review was conducted across five emergency departments operated by the ChildLife Foundation over a six-month period, from December1,2024, to May31, 2025.Data collected through Electronic Medical Record system,including age,presenting complaints,triage category at time of revisits,disposition outcome.

RESULTS
Total registered patients during study period were 134,000. Discharged patients were 87,000. Revisited patients were 2901 with revisit rate of 3.3%.The most common revisited age group was child aged 1till 5 years1235(43%). The majority of patients were triaged as Priority 2 (P2), accounting for 2,420 cases (83%).The most frequent presenting complaints were gastrointestinal 1060(37) followed by respiratory 930(32%),fever532(18%) and others379(13%).Regarding revisit outcomes,1,290 patients (45%) were discharged home, 739 patients (26%) required hospital admission, 475 patients (16%)were LAMA cases, 232 patients (8%)referred,157 patients(5%)were discharged on request (DOR), and 8 patients (0.2%) were reported deceased

CONCLUSION
Patterns of this study indicate that many presentations can be effectively diverted from emergency service. Good amount of return patients required admission indicating a worsen clinical condition, could be due to misdiagnoses, inadequate treatment or early discharge. Implementing standardized safe discharge protocols and reinforcing caregiver understanding are therefore key strategies to optimize resource utilization and strengthen the overall quality of pediatric emergency services.

Keywords: Emergency Department,Pediatric Revisits,Unscheduled Return