Recurrent pediatric emergency department visits among technology-dependent children: a single-center retrospective cohort study

Advances in medical technology have increased the number of children who depend on long-term medical devices to sustain vital functions. In this study, we aimed to evaluate the reasons for and problems associated with pediatric emergency department (ED) visits among technology-dependent children. Technology-dependent patients aged 1 month to 18 years who presented to the pediatric ED of a university hospital between October 2019 and December 2022 were retrospectively reviewed. A total of 367 ED visits by 53 patients were evaluated. The median age at first presentation was 47 months; 64% of patients were male, and 92.5% had a neurological underlying condition (most commonly cerebral palsy). Of the visits, 97.5% were made via the 112 emergency ambulance system and 68.4% occurred during working hours. The two most common reasons for presentation were non-device-related acute complaints (38.4%; chiefly fever and low oxygen saturation) and routine check-ups without an active complaint (34.6%; mainly outpatient clinic control, scheduled tube changes, and medical report renewal). Pneumonia was the most common reason for pediatric intensive care unit (PICU) admission (67.7%); 65.9% of visits resulted in discharge from the ED. Eight of the 53 patients (15%, 95% CI 7.9–27.1%) died during the study period. In cluster-robust multivariable analysis, a neurological primary diagnosis and non-working-hours presentation were independently associated with PICU admission, while working-hours presentation was the strongest independent predictor of a potentially-preventable visit (OR 5.39). In this cohort of technology-dependent children with predominantly neurological conditions, a substantial proportion of ED visits appeared potentially preventable; these findings apply primarily to children with neurological complexity rather than to those with isolated cardiac or respiratory conditions. Routine check-up visits appeared to reflect limited access to daytime ambulatory follow-up and scheduled device-change services rather than acute need. Because working-hours presentation was the strongest predictor of potentially preventable visits, strengthening daytime primary and outpatient care access, such as same-day device clinics, together with specialized home care and palliative care services, may redirect these visits away from the ED, complemented by caregiver education, scheduled cannula/tube changes, and regular device maintenance.