Purpose: Return to the emergency department (ED) after discharge may cause a considerable increase in the workload together with financial loss and great discomfort to patients. Abdominal CT is selectively utilized for patients with high clinical suspicion of abdominal disease.
We aimed to evaluate the 2, 7 and 30-day return rates of patients who were discharged from the ED after undergoing an abdominal CT, and to evaluate which features were associated with the higher 2 days return rates.
Methods: We collected all records of patients who were discharged from the ED (tertiary medical center) between 1/1/2012 and 31/12/2018. We included adult patients (ages 18 – 100). For each patient, we assessed whether they returned to the ED within 2, 7 to 30 days and calculated the respective return rates for patients who did and did not undergo CT in the ED.
We retrieved the following features for the study cohort: demographics, home medications, comorbidities, vital signs, emergency severity index, pain score, laboratory results, ED clinical discharge diagnosis. We evaluated which features were associated with higher return rates.
Results: Overall, 511,383 adult patients were discharged from the ED, of them 6,102 (1.2%) patients were discharged after undergoing abdominal CT. For patients who underwent abdominal CT the 2, 7 and 30-day return rates were 453 (7.4%), 588 (9.6%) and 832 (13.6%), respectively. For patients who did not undergo abdominal CT the 2, 7 and 30-day return rates were 29767 (5.8%), 42,423 (8.3%) and 65,482 (12.8%), respectively.
Features associated with higher 2 days return rates in patients that underwent abdominal CT compared to general population include: oncological disease (13.9% vs. 6.6% p<0.05), C-Reactive protein (CRP) (48.4 vs. 25.7 p<0.05), diabetes mellitus (11.5% vs. 7.5% p<0.05), creatine phosphokinase (CPK) (213 mg% vs. 150 mg% p<0.05) and pain score (6.1 vs. 4.4 p<0.05).
Conclusion: The 2, 7 and 30-day return rates for patients who underwent abdominal CT in the ED were higher compared to general population. In patients that underwent abdominal CT in the ED and were then discharged, the majority of 30-day returns were already within the first 2 days. Features associated with higher returns include oncological disease, CRP, diabetes, CPK and higher pain score.
