Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study
- 1Department of Emergency Nursing, West China Second University Hospital, Sichuan University
- 2Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
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.
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BibTeX
@article{zhao2026clinical,
title = {{Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study}},
author = {Jing Zhao and Lingli Pan and Qiu Jin and Jie Gao and Min Cheng},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1955991},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955991/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical and diagnostic factors associated with 72-h unscheduled return to high-priority pediatric emergency care: a health services retrospective cohort study
AU - Jing Zhao
AU - Lingli Pan
AU - Qiu Jin
AU - Jie Gao
AU - Min Cheng
PY - 2026
DA - 2026/10/19
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1955991
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955991/full
AB - 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.
SN - 2296-2565
ER -