76 Unscheduled Return Visits for Gastroenteritis to a Pediatric Emergency Department
Bibliographic record
Abstract
To determine the reasons for unscheduled return visits in patients with presumed acute viral gastroenteritis and attempt to identify potential prevention strategies. A retrospective chart review of all patients seen in the Emergency Department of the Children's Hospital of Eastern Ontario from February to June 2002, with a discharge diagnosis of gastroenteritis, who had an unscheduled return visit within 7 days. Between February and June 2002, 1862 patients had a discharge diagnosis of gastroenteritis, including 128 return visits by 121 patients. Patients were excluded if the return visit was not within 7 days (4), the patient was asked to return (2), the patient had an acute or chronic co-morbidity (6) or had no diarrhea at either visit (8), leaving 108 (6%) visits for study. Five patients had a second repeat visit. The number of days between all visits was 1.8±1.2 SD. The patient population was 2.6±2.8 SD years of age. Five patients were under 3 months of age, but none were under one month of age. There was no statistical significance between triage category (acuity) on the first visit compared to the second (p<0.89 according to the Sign Test). On return visits a total of 177 symptoms of concern to the parents were identified. These included persistent vomiting 39 (22%), persistent diarrhea 38 (21%), persistent fever 4 (2%), worsening vomiting 17 (10%), worsening diarrhea 24 (14%), worsening fever 2 (1%), new-onset vomiting 3 (2%), new-onset diarrhea 12 (7%), new-onset fever 9 (5%), decreased intake 15 (8%), decreased voiding 5 (3%), and lethargy 5 (3%). New onset abdominal pain, bloody diarrhea and epistaxis accounted for one visit each. Intravenous therapy was instituted to 28% of patients returning to the emergency department and of these 4.6% were admitted to hospital. Discharge information sheets were given to 47% of patients after the first visit. Using criteria from our discharge information sheet, only 56 (52%) of return visits were deemed appropriate (lethargy, hydration issues, or new symptoms such as abdominal pain, bloody stools or fever). Almost half (48%) of the return visits for gastroen-teritis represent patients with expected symptomatology (i.e. new-onset or persistence of diarrhea). Some visits could potentially be prevented by providing consistent verbal and written discharge information to parents regarding the natural history of acute viral gastroenteritis. Further study is required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".