Noncompliance with scheduled revisits to a pediatric emergency department

Objectives: To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED). Design: A prospective, inceptive cohort study. Setting: An urban pediatric ED. Patients: A sample of 179 children. Interventions: Interviews of parents and physicians. Results: Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because 'the child was better.' Of the 124 patients who ED physicians believed were 'certain to return,' 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory, testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged 'not certain' to return (RR, 1.34; 95% CI, 1.01-1.78). Conclusions: The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.