Lit Matters #3: The Number of Abnormal Vitals at Discharge Matters

An isolated abnormal vital sign at pediatric ED discharge did not increase 48-hour bounceback risk in a large multicenter cohort. The signal changes when abnormalities stack up: two or more abnormal discharge vitals were associated with more revisits, and low oxygen saturation carried a much higher chance of admission on return.

Pediatric discharge vital signs

• Isolated abnormal vital sign: A single abnormal discharge vital sign was common and not associated with higher 48-hour ED revisit rates, a useful counterweight to the reflex that every number must normalize before discharge.
• Multiple abnormal vital signs: The pattern that mattered was accumulation: children discharged with two or more abnormal vital signs were more likely to bounce back, and we get into the disposition nuance in the episode.
• Low oxygen saturation signal: Hypoxemia stood out from the rest: low discharge oxygen saturation was not linked to more revisits overall, but every child who returned after being discharged hypoxemic was admitted.
• Abnormal temperature association: Fever was the abnormal vital sign most clearly associated with revisit risk, reinforcing the practical point that treating temperature can improve comfort even when it does not change the diagnosis.
• Younger age and acuity: Children under 3 years old and those triaged ESI 1 to 3 were more likely to revisit and need admission, so the illness context still matters more than any isolated discharge number.
• Serious adverse event rate: Even among bouncebacks, severe outcomes were rare: most admissions were to the general floor, only a few required surgery or PICU, and there were no deaths, CPR, or intubations.