{
  "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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusion: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Emergency Nursing, West China Second University Hospital, Sichuan University",
    "Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Jing Zhao"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lingli Pan"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Qiu Jin"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jie Gao"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Min Cheng"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5mm40yfvdq5nb.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1955991",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724413/?tool=EBI",
  "id": "5mm40yfvdq5nb",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955991/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2711|Emergency and Acute Care Studies"
    ]
  ],
  "openalex": "W7222926191",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1955991/pdf",
  "pmcid": "PMC13724413",
  "pmid": "42973530",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/5mm40yfvdq5nb.ris",
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      "native_id": "10.3389/fpubh.2026.1955991",
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      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955991/full"
    },
    {
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  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
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  ],
  "title": "Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study",
  "title_text": "Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:54Z",
  "url": "https://research.draconitic.com/paper/5mm40yfvdq5nb",
  "venue": "Frontiers in Public Health",
  "versions": []
}