34 Predictors of bounce back for children redirected by triage nurse from the paediatric emergency department
Bibliographic record
Abstract
Abstract Background To address the overcrowding, our paediatric emergency department (ED) implemented a procedure to redirect non-emergency patients. Using a standardized guideline, triage nurses can redirect children to external paediatric clinic, alternative professional, family doctor or home. Objectives This study aimed to identify the proportion of children who returned to the ED after redirection and to identify predictors of these return visits. Design/Methods We conducted a retrospective cohort study involving all children 18 years and under who were redirected from the ED of a tertiary care paediatric hospital in Montreal. Of them, a random sample of 150 return visits and 300 controls were selected to be included in a nested case-control study. The primary outcome was a return visit to the same ED within seven days. Potential predictors of return visits included demographic information, disease characteristics, triage scores and disposition. A 10% random sample was evaluated in duplicate. The primary analysis was the proportion of return visits among all redirected children. Subsequently, a multivariate logistic regression analysis was performed to identified independent variables associated with the return visits. It was estimated that evaluation of at least 100 cases of return visit would allow an evaluation of 10 independent variables. Results Between September 2023 and August 2024, 80 221 children were evaluated in the ED of whom 6 556 (8.2%) patients were redirected: 372 (5.7%) redirected children returned to the ED in the seven days. The inter-rater reliability evaluation demonstrated Kappa scores or intraclass correlation coefficient higher than 0.6 for all variables. Of the 150 return visits, 127 (85%; 95%CI: 78-90%) were related to the initial chief complaint: 64 (43%; 95%CI: 35-51%) for persistence of symptoms and 49 (33%; 95%CI: 26-41%) for clinical deterioration. Seven (5%; 95%CI: 2-9%) returning patients were hospitalized. Factors associated with a higher risk of return visit included abdominal complaint, fever at triage and patients redirected home. Patients with dental problems and redirected to specialized clinics were at lower risk of return. Conclusion This study identified that 6% of children redirected from the CHU Sainte-Justine triage returned to the same ED within seven days of initial presentation, most commonly for persistence or deterioration of symptoms. The knowledge of predictors of these return visits can improve reorientation guidelines and help the Quebec health care system to develop more focused interventions for reorientation.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 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".