Predictors of emergency department utilisation in children with complex chronic conditions: a retrospective longitudinal cohort study

Background: Children with complex chronic conditions (CCCs) frequently revisit emergency departments (EDs), increasing demand on acute services and challenging care coordination. Aims: To identify clinical and family factors associated with higher ED utilisation in children with CCCs and to characterise frequent service use (FSU). Methods: Retrospective longitudinal cohort at a tertiary hospital in Spain (2015–2021). We included 248 children <18 years with CCCs (Feudtner v2), regardless of ED use. Recurrent ED visits were modelled using a Cox Andersen–Gill approach from discharge of the index ED visit. Global FSU was described as ⩾8 ED visits during 2015–2021. Results: Overall, 240/248 (96.8%) children attended the ED (mean 13.0 visits; median 8, IQR 4–18). Higher hazards of ED revisits were associated with non-malignant CCC macro-groups, rehabilitation enrolment, higher urgent and scheduled hospitalisation counts and any PICU admission (C-index ≈ 0.71). Conclusion: Routinely recorded factors may support risk stratification and coordinated follow-up for children with CCCs. Contribution to nursing: This study strengthens nursing knowledge on continuity and family-centred complex care by identifying clinically relevant risk profiles in a tertiary-care cohort. Multicentre validation and prospective evaluation are needed before specific service models can be recommended.