Which factors predicting ARI-related readmission to ED?

In the postpandemic period, readmissions to the emergency department (ED) for paediatric acute respiratory infections (ARI) appear to be driven by several factors, suggests a study.

“Contributing factors range from the initial severity of the clinical condition to the specific characteristics of the patients,” the investigators said. 

This retrospective 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 1 July 2021 and 30 June 2023. The investigators estimated the risk of return to ED in terms of variables related to access, patient characteristics, and pharmacologic treatment using a multivariate logistic regression model.

A total of 2,987 ED readmissions within 7 days of discharge occurred during the study period. This represented 8.8 percent of the 33,933 ARI-related ED visits with discharge to home. [Pediatr Infec Dis J 2025;44:1153-1158]

In multivariate analysis, several factors contributed to ARI-related readmission to the ED, 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.

“Recognizing and understanding these determinants offers an opportunity to develop targeted interventions aimed at optimizing the discharge process,” the investigators said. “Such interventions could enhance the guidance provided to parents and caregivers regarding warning signs and home monitoring strategies.”

Patient characteristics

Children aged <1 year and preschool-age children appeared to be at greatest risk of readmission to the ED, based on previous studies. [Emerg Med Australas 2022;34:584-589; Pediatr Emerg Care 2006;22:545-549; PLoS One 2022;17:e0262432]

In the present study, a reduction in the risk of readmission was observed with increasing age, up to the 5–9 years age group. This was followed by an increase in the probability of readmission in patients aged >10 years.

"This trend could be explained by greater parental concern regarding symptom deterioration in younger children and the presence of comorbidities in older patients,” the investigators said. 

“However, due to limitations related to the availability of computerized data, our study only analysed the presence of secondary diagnoses as a proxy of the presence of comorbidities, which are also a well-documented risk factor for readmission to the ED,” they added. [Pediatr Emerg Care 2005;21:816-821]

In terms of the level of emergency severity at the initial ED visit, as shown by the triage code, the current findings support those of earlier studies, which showed an elevated readmission risk as the severity of the condition worsened. A much higher risk was noted for acute cases. [Pediatr Emerg Care 2004;20:166-171; Pediatr Emerg Care 2015;31:819-824]

“Furthermore, the implementation of advanced predictive models, leveraging technologies such as artificial intelligence and machine learning, may play a pivotal role in the early identification of patients at higher risk for ED readmission,” the investigators said. 

“By training these models on extensive datasets encompassing clinical, sociodemographic, and behavioural data, it becomes possible to predict the likelihood of unplanned readmissions with high precision, thus supporting clinical decision-making during the discharge process,” they added.