Background and Objectives: This study aims to identify reasons for unscheduled return\nvisits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from\na similar study conducted in the same institution 9 years ago. Materials and Methods: This\nretrospective study included adult patients who attended the emergency department (ED) of a\ntertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h\nfor the same or similar complaint. The primary outcome was wrong or delayed diagnoses.\nSecondary outcomes include admission to the ED observation unit or ward on return visit. Findings\nwere compared with the previous study performed in 2005 to identify trends. Results: Of 67,422\nattendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range\n24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%).\nOne hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors\n(adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain\n(2.99; 2.12-4.23), fever (1.60; 1.1-2.33), neurological deficit (4.26; 1.94-9.35), and discharge without\nfollow-up (1.61; 1.1-2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted\nodds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities\nof diabetes mellitus (2.07; 1.29-3.31), asthma (5.23; 1.59-17.26), and renal disease (7.48; 2.00-28.05);\npresenting complaints of abdominal pain (1.83; 1.32-2.55), fever (3.05; 2.10-4.44), and giddiness or\nvertigo (2.17; 1.26-3.73). There was a reduction in URV rate compared to the previous study in 2005\n(1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2%\nversus 25.1%). Conclusions: Presenting complaints of neurological deficits, abdominal pain, fever,\nand discharge without follow-up were associated with wrong or delayed diagnoses among URVs.
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