Changing Presenting Complaints During 72-Hour Emergency Department Revisits: Associations with Functional Status and Revisit Outcomes

Background: Emergency department (ED) revisits within 72 h are commonly used as indicators of healthcare quality and have been associated with adverse clinical outcomes. Some patients return with presenting complaints that differ from those reported during the initial ED encounter; however, factors associated with this phenomenon have not been well described. Methods: This retrospective cohort study analyzed electronic health record data from a regional teaching hospital in Taiwan between 2016 and 2023. Adult patients with unscheduled ED revisits within 72 h were included. Documented presenting complaints recorded at the index visit and revisit were compared according to predefined operational definitions and categorized as consistent or changing. Multivariable logistic regression was used to identify factors associated with complaint consistency. Revisit disposition was also examined. Results: A total of 1957 patients met the study criteria, of whom 809 (41.3%) had changing presenting complaints. Compared with patients with consistent presenting complaints, those with changing presenting complaints were older and had lower activities of daily living (ADL) scores. In multivariable analysis, male sex was independently associated with complaint consistency (OR 1.41, p = 0.002), whereas increasing age was associated with a lower likelihood of consistency (OR 0.99 per year, p < 0.001). Higher ADL scores were also associated with complaint consistency (OR 1.04 per point, p = 0.023). Revisit disposition distributions differed significantly between the two groups (p = 0.005). In the unadjusted analysis, patients with changing documented presenting complaints were more frequently hospitalized, transferred, or died during the revisit than patients with consistent documented presenting complaints. Conclusions: Changing documented presenting complaints were associated with older age and poorer functional status. An unadjusted difference in revisit disposition distributions was also observed between the two groups. These findings are hypothesis-generating and require prospective validation before their clinical utility can be determined.