Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Seventy-two-hour unscheduled return visits reflect short-term emergency care reutilization, discharge-transition safety, and disease progression in children. Evidence is limited for children managed through high-priority pediatric emergency care pathways, where triage acuity, observation needs, and disease-specific care processes differ from standard emergency department care. This study examined clinical and diagnostic factors associated with 72-h unscheduled return to such a pathway and assessed whether these associations differed between red-zone and yellow-zone encounters. Methods We conducted a retrospective cohort study of 30,170 pediatric visits from 24,479 children managed through an institutionally defined high-priority pediatric emergency care pathway at a tertiary women’s and children’s hospital in China in 2025. The primary outcome was unscheduled return to the same pathway within 72 h after the index visit. Visits were ordered chronologically within each child. Mixed-effects logistic regression with a patient-level random intercept was used to account for repeated visits. Zone and triage level were not included together because they were structurally linked in the institutional workflow. Results Overall, 1,507 index visits were followed by a 72-h return (5.0%). In the primary model, yellow-zone encounters had higher odds of return than red-zone encounters (adjusted odds ratio [aOR], 2.28; 95% confidence interval [CI], 1.34–3.87). Oncologic conditions showed the strongest association with return (aOR, 6.48; 95% CI, 3.54–11.87), followed by hematologic diseases (aOR, 2.49; 95% CI, 1.06–5.89). The zone-by-diagnosis interaction model indicated that the oncologic risk signal was amplified in the yellow zone (interaction aOR, 5.10; 95% CI, 1.25–20.84; p = 0.023). The oncologic association remained stable across sensitivity analyses. Conclusion In this high-priority pediatric emergency care pathway, 72-h unscheduled return was more closely related to the underlying diagnostic category than to initial vital-sign abnormality. Yellow-zone children with oncologic conditions may require strengthened discharge assessment, explicit return precautions, and short-interval follow-up to improve care-transition safety and support risk-informed use of high-priority emergency resources.
Source: Frontiers in Public Health
Authors: Jing Zhao, Lingli Pan, Qiu Jin, Jie Gao, Min Cheng
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222926191