Nonspecific Diagnoses and Return Visits Among Children Discharged From the Emergency Department.

Abstract

Previous work has suggested an association between diagnostic uncertainty and the use of nonspecific diagnostic billing codes. We sought to evaluate differences in emergency department (ED) return visits among children discharged from the ED with specific and nonspecific discharge diagnosis codes. We performed a retrospective study including children (aged <18 years) discharged from 40 pediatric EDs between July 2021 and June 2022. Our primary and secondary outcomes were 7-day and 30-day ED return visits, respectively. Our predictor of interest was diagnosis, classified as nonspecific (only signs/symptoms diagnoses, e.g., "cough") or specific (≥1 specific diagnosis, e.g., "pneumonia"). We evaluated for associations using Cox proportional hazard models adjusted for race/ethnicity, payer status, age, medical complexity, and neighborhood opportunity. Among 1870100 discharged children, 7-day return visits occurred in 73956 (4.0%); of these, 15.8% had nonspecific discharge diagnoses. The adjusted hazard ratio (aHR) of a return visit among children with a nonspecific diagnosis on their index visit was 1.08 (95% confidence interval, 1.06-1.10). Nonspecific diagnoses with the highest aHR of return visits were for fever, convulsions, digestive system, abdominal signs/symptoms, and headache. Respiratory and emotional/behavior signs or symptoms had a lower aHR of 7-day return visits. The aHR of nonspecific diagnosis on 30-day return visits was 1.01 (95% confidence interval 1.01-1.03). Children with nonspecific diagnoses discharged from the ED had distinct patterns of health care utilization compared with those having specific diagnoses. Further research is required to evaluate the role of diagnostic uncertainty with diagnosis code application in the ED.