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An Innovative Model to Predict Pediatric Emergency Department Return Visits

Bergese, Ilaria RN, MNS*; Frigerio, Simona RN, MNS, PhD; Clari, Marco RN, MNS; Castagno, Emanuele MD, PhD*; De Clemente, Antonietta RN, MNS; Ponticelli, Elena RN, MNS; Scavino, Enrica RN, MNS§; Berchialla, Paola PhD

doi: 10.1097/PEC.0000000000000910
Original Articles

Objectives Return visit (RV) to the emergency department (ED) is considered a benchmarking clinical indicator for health care quality. The purpose of this study was to develop a predictive model for early readmission risk in pediatric EDs comparing the performances of 2 learning machine algorithms.

Methods A retrospective study based on all children younger than 15 years spontaneously returning within 120 hours after discharge was conducted in an Italian university children's hospital between October 2012 and April 2013. Two predictive models, artificial neural network (ANN) and classification tree (CT), were used. Accuracy, specificity, and sensitivity were assessed.

Results A total of 28,341 patient records were evaluated. Among them, 626 patients returned to the ED within 120 hours after their initial visit. Comparing ANN and CT, our analysis has shown that CT is the best model to predict RVs. The CT model showed an overall accuracy of 81%, slightly lower than the one achieved by the ANN (91.3%), but CT outperformed ANN with regard to sensitivity (79.8% vs 6.9%, respectively). The specificity was similar for the 2 models (CT, 97% vs ANN, 98.3%). In addition, the time of arrival and discharge along with the priority code assigned in triage, age, and diagnosis play a pivotal role to identify patients at high risk of RVs.

Conclusions These models provide a promising predictive tool for supporting the ED staff in preventing unnecessary RVs.

From the *Department of Pediatric Emergency, Regina Margherita Children's Hospital of Torino, and

Città della Salute e della Scienza di Torino University Hospital;

Azienda Sanitaria Locale TO5, Chieri;

§Cottolengo Hospital; and

Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.

Disclosure: The authors declare no conflict of interest.

Reprints: Ilaria Bergese, RN, MNS, Department of Pediatric Emergency, Regina Margherita Children's Hospital, Città della Salute e della Scienza di Torino University Hospital, Piazza Polonia 94, 10126, Turin, Italy (e-mail:

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