Incidence of unscheduled return visits in emergency department: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2025.05.006

Abstract

Abstract:

Objective

To systematically evaluate the incidence rate of unscheduled return visits (URV) in the emergency department.

Methods

Observational studies reporting the URV incidence in the emergency department were retrieved from ten databases (CBM, CNKI, Wanfang, VIP, PubMed, Embase, CINAHL, Cochrane Library, Web of Science, and ProQuest) from their inception to February 2025. After literature search, screening, and data extraction by two researchers, a meta-analysis was performed using R software.

Results

Twelve studies were included, with 11 239 523 emergency department patients. The meta-analysis showed that the overall incidence of URV among emergency department patients was 7.22% [95% confidence interval (CI) (4.28%, 10.17%), Z = 4.808, P < 0.001]. Subgroup analysis showed that patients aged 40 to < 60 years old, with a return visit interval of 30 days, from North America, and in the emergency department observation unit had a higher incidence of URV (all P < 0.05).

Conclusion

Patients aged 40 to < 60 years old, with a return visit interval of 30 days, from North America, and in the emergency department observation unit have a higher incidence of URV.

Key words: Unscheduled return visits, Emergency department, Meta-analysis

Ye Xu, Limei Cui, Kexin Ji, Lixia Ye, Xuehong Zhao. Incidence of unscheduled return visits in emergency department: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2025, 18(05): 397-402.

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References 35

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纳入研究	样本来源	研究类型	重返时间间隔	URV发生率[例数/总样本量，（%）]	NOS评分（分）
Hiti等^[10]	≥ 18岁急诊科患者	病例对照研究	72 h	1 183/38 886（3.04）	8
Chan等^[11]	急诊科患者	回顾性队列研究	72 h	3 065/94 350（3.25）	6
Chang等^[12]	≥ 18岁急诊科患者	回顾性队列研究	72 h	4 582/119 452（3.84）	7
van Loon-van Gaalen等^[13]	≥ 70岁急诊科患者	前瞻性队列研究	30 d	222/1 659（13.38）	7
de Gelder等^[14]	≥ 70岁急诊科患者	多中心队列研究	30 d	114/1 093（10.43）	8
Soh等^[15]	≥ 18岁急诊科患者	回顾性队列研究	72 h	1 298/67 422（1.93）	6
Ross等^[16]	急诊科观察单元患者	前瞻性队列研究	14 d	375/3 509（10.69）	7
Hahn等^[17]	急诊科观察单元患者	回顾性队列研究	30 d	2 252/14 910（15.10）	7
Dinh等^[18]	急诊科患者	回顾性队列研究	72 h	535 079/10 787 797（4.96）	6
Lowthian等^[19]	≥ 65岁急诊科患者	前瞻性队列研究	30 d	140/959（14.60）	8
Wu等^[20]	急诊科患者	回顾性队列研究	72 h	1 899/34 714（5.47）	6
Loi等^[21]	≥ 18岁急诊科患者	回顾性队列研究	9d	492/74 772（0.66）	6

纳入研究	样本来源	研究类型	重返时间间隔	URV发生率[例数/总样本量，（%）]	NOS评分（分）
Hiti等^[10]	≥ 18岁急诊科患者	病例对照研究	72 h	1 183/38 886（3.04）	8
Chan等^[11]	急诊科患者	回顾性队列研究	72 h	3 065/94 350（3.25）	6
Chang等^[12]	≥ 18岁急诊科患者	回顾性队列研究	72 h	4 582/119 452（3.84）	7
van Loon-van Gaalen等^[13]	≥ 70岁急诊科患者	前瞻性队列研究	30 d	222/1 659（13.38）	7
de Gelder等^[14]	≥ 70岁急诊科患者	多中心队列研究	30 d	114/1 093（10.43）	8
Soh等^[15]	≥ 18岁急诊科患者	回顾性队列研究	72 h	1 298/67 422（1.93）	6
Ross等^[16]	急诊科观察单元患者	前瞻性队列研究	14 d	375/3 509（10.69）	7
Hahn等^[17]	急诊科观察单元患者	回顾性队列研究	30 d	2 252/14 910（15.10）	7
Dinh等^[18]	急诊科患者	回顾性队列研究	72 h	535 079/10 787 797（4.96）	6
Lowthian等^[19]	≥ 65岁急诊科患者	前瞻性队列研究	30 d	140/959（14.60）	8
Wu等^[20]	急诊科患者	回顾性队列研究	72 h	1 899/34 714（5.47）	6
Loi等^[21]	≥ 18岁急诊科患者	回顾性队列研究	9d	492/74 772（0.66）	6

研究	效应量	95%CI	权重
Hiti等^[10]	3.04	2.87 ~ 3.22	8.4
Chan等^[11]	3.25	3.14 ~ 3.36	8.4
Chang等^[12]	3.84	3.73 ~ 3.95	8.4
van Loon-van Gaalen等^[13]	13.38	11.78 ~ 15.11	8.2
de Gelder等^[14]	10.43	8.68 ~ 12.40	8.2
Soh等^[15]	1.93	1.82 ~ 2.03	8.4
Ross等^[16]	10.69	9.68 ~ 11.76	8.3
Hahn等^[17]	15.10	14.53 ~ 15.69	8.4
Dinh等^[18]	4.96	4.95 ~ 4.97	8.4
Lowthian等^[19]	14.60	12.42 ~ 16.99	8.0
Wu等^[20]	5.47	5.23 ~ 5.71	8.4
Loi等^[21]	0.66	0.60 ~ 0.72	8.1
合并效应量	7.22	4.28 ~ 10.17	100.0

研究	效应量	95%CI	权重
Hiti等^[10]	3.04	2.87 ~ 3.22	8.4
Chan等^[11]	3.25	3.14 ~ 3.36	8.4
Chang等^[12]	3.84	3.73 ~ 3.95	8.4
van Loon-van Gaalen等^[13]	13.38	11.78 ~ 15.11	8.2
de Gelder等^[14]	10.43	8.68 ~ 12.40	8.2
Soh等^[15]	1.93	1.82 ~ 2.03	8.4
Ross等^[16]	10.69	9.68 ~ 11.76	8.3
Hahn等^[17]	15.10	14.53 ~ 15.69	8.4
Dinh等^[18]	4.96	4.95 ~ 4.97	8.4
Lowthian等^[19]	14.60	12.42 ~ 16.99	8.0
Wu等^[20]	5.47	5.23 ~ 5.71	8.4
Loi等^[21]	0.66	0.60 ~ 0.72	8.1
合并效应量	7.22	4.28 ~ 10.17	100.0

亚组	文献（篇）	异质性检验结果		效应模型	Meta分析结果（%）		Q值	P值
亚组	文献（篇）	I²（%）	P值	效应模型	发生率	95%CI	Q值	P值
性别
男	5	99.8	<0.001	随机	6.343	3.259~11.982	0.170	0.684
女	3	99.9	<0.001	随机	4.926	1.722~13.287
年龄（岁）							28.954	<0.001
20 ~<40	2	99.8	<0.001	随机	4.454	2.921~6.736
40 ~<60	3	99.0	<0.001	随机	4.751^a	3.728~6.039
60 ~<80	2	98.8	<0.001	随机	3.443	2.722~4.346
≥80	2	0.0	0.939	固定	2.729	2.697~2.762
重返时间间隔							548.441	<0.001
72 h	6	99.9	<0.001	随机	3.746	2.703~4.789
30 d	4	88.2	<0.001	随机	13.436	11.378~15.495
发表地区							44.439	<0.001
亚洲	6	99.9	<0.001	随机	3.028	1.714~4.342
北美洲	2	98.2	<0.001	随机	12.916^b	8.588~17.245
大洋洲	2	98.6	<0.001	随机	9.712	0.267~19.156
欧洲	2	82.2	0.018	随机	11.932	9.040~14.824
样本来源							6.513	0.011
急诊科	10	100.0	<0.001	随机	6.072	3.090~9.054
急诊科观察单元	2	98.2	<0.001	随机	12.916	8.588~17.245
主诉							7.447	0.189
腹痛	3	97.2	<0.001	随机	9.975	4.610~20.259
背痛	2	95.2	<0.001	随机	7.436	2.956~17.486
胸痛	3	95.0	<0.001	随机	9.015	5.576~14.255
晕厥	3	50.0	0.135	随机	11.434	9.957~13.098
泌尿道问题	2	97.3	<0.001	随机	11.753	3.832~30.803
头疼	2	0.0	0.416	固定	18.110	12.341~25.783

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