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Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients.
J Crit Care. 2011 Dec; 26(6):620-5.JC

Abstract

INTRODUCTION

Transfer of critically ill patients from outside emergency department has the potential for delaying the admission to the intensive care unit. We sought to determine the effect of outside emergency department transfer on hospital outcomes in critically ill patients with stroke.

METHODS

We designed a retrospective cohort analysis using a prospectively compiled and maintained registry (Cerner Project IMPACT). Patients with acute ischemic stroke and intracerebral hemorrhage admitted to our intensive care unit from our emergency department and transfers from outside emergency department within 24 hours of stroke between January 1, 2003, and December 31, 2008, were selected for the analysis. Data collected included demographics, admission physiologic variables, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II score, and total intensive care unit and hospital length of stay. Primary (poor) outcome was a composite of death or fully dependent status at hospital discharge, and secondary outcomes were intensive care unit and hospital length of stay. To assess for the impact of outside emergency department transfer on primary and secondary outcomes, demographic and admission clinical variables were used to construct logistic regression models using the outcome measure as a dependent variable.

RESULTS

A total of 448 patients were selected for analysis. The mean age was 65 ± 14 years, of which 214 (48%) were male and 282 (65%) white, 152 (34%) were patients with acute ischemic stroke, and 296 (66%) were patients with intracerebral hemorrhage. The median hospital length of stay was 7 days (interquartile range, 4-11 days) and median intensive care unit length of stay was 2 days (interquartile range, 1-3 days). Overall hospital mortality was 30%, and outside emergency department transfer increased the odds of poor outcome by 2-fold (65% vs 34%; P = .05). Multivariate regression analysis showed that age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.1), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 1.9; 95% CI, 1.3-2.7), Glasgow Coma Scale <12 (OR, 2.0; 95% CI, 1.4-2.8), do-not-resuscitate status (OR, 3.5; 95% CI, 2.2-5.9), and outside emergency department transfers (OR, 1.4; 95% CI, 1.02-1.8) were independently associated with poor outcome. Outside emergency department transfer was not significantly associated with secondary outcomes.

CONCLUSION

These data suggest that in critically ill patients with stroke, transfer from outside emergency department is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect.

Authors+Show Affiliations

Division of Neurology, Department of Medicine, Cooper University Hospital, Robert Wood Johnson Medical School, UMDNJ, Camden, NJ 08103, USA. fred.rincon@jefferson.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21596517

Citation

Rincon, Fred, et al. "Association Between Out-of-hospital Emergency Department Transfer and Poor Hospital Outcome in Critically Ill Stroke Patients." Journal of Critical Care, vol. 26, no. 6, 2011, pp. 620-5.
Rincon F, Morino T, Behrens D, et al. Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients. J Crit Care. 2011;26(6):620-5.
Rincon, F., Morino, T., Behrens, D., Akbar, U., Schorr, C., Lee, E., Gerber, D., Parrillo, J., & Mirsen, T. (2011). Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients. Journal of Critical Care, 26(6), 620-5. https://doi.org/10.1016/j.jcrc.2011.02.009
Rincon F, et al. Association Between Out-of-hospital Emergency Department Transfer and Poor Hospital Outcome in Critically Ill Stroke Patients. J Crit Care. 2011;26(6):620-5. PubMed PMID: 21596517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between out-of-hospital emergency department transfer and poor hospital outcome in critically ill stroke patients. AU - Rincon,Fred, AU - Morino,Tricia, AU - Behrens,Danielle, AU - Akbar,Umer, AU - Schorr,Christa, AU - Lee,Elizabeth, AU - Gerber,David, AU - Parrillo,Joseph, AU - Mirsen,Thomas, Y1 - 2011/05/18/ PY - 2010/12/06/received PY - 2011/02/16/revised PY - 2011/02/20/accepted PY - 2011/5/21/entrez PY - 2011/5/21/pubmed PY - 2012/4/11/medline SP - 620 EP - 5 JF - Journal of critical care JO - J Crit Care VL - 26 IS - 6 N2 - INTRODUCTION: Transfer of critically ill patients from outside emergency department has the potential for delaying the admission to the intensive care unit. We sought to determine the effect of outside emergency department transfer on hospital outcomes in critically ill patients with stroke. METHODS: We designed a retrospective cohort analysis using a prospectively compiled and maintained registry (Cerner Project IMPACT). Patients with acute ischemic stroke and intracerebral hemorrhage admitted to our intensive care unit from our emergency department and transfers from outside emergency department within 24 hours of stroke between January 1, 2003, and December 31, 2008, were selected for the analysis. Data collected included demographics, admission physiologic variables, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II score, and total intensive care unit and hospital length of stay. Primary (poor) outcome was a composite of death or fully dependent status at hospital discharge, and secondary outcomes were intensive care unit and hospital length of stay. To assess for the impact of outside emergency department transfer on primary and secondary outcomes, demographic and admission clinical variables were used to construct logistic regression models using the outcome measure as a dependent variable. RESULTS: A total of 448 patients were selected for analysis. The mean age was 65 ± 14 years, of which 214 (48%) were male and 282 (65%) white, 152 (34%) were patients with acute ischemic stroke, and 296 (66%) were patients with intracerebral hemorrhage. The median hospital length of stay was 7 days (interquartile range, 4-11 days) and median intensive care unit length of stay was 2 days (interquartile range, 1-3 days). Overall hospital mortality was 30%, and outside emergency department transfer increased the odds of poor outcome by 2-fold (65% vs 34%; P = .05). Multivariate regression analysis showed that age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.01-1.1), Acute Physiology and Chronic Health Evaluation II score >14 (OR, 1.9; 95% CI, 1.3-2.7), Glasgow Coma Scale <12 (OR, 2.0; 95% CI, 1.4-2.8), do-not-resuscitate status (OR, 3.5; 95% CI, 2.2-5.9), and outside emergency department transfers (OR, 1.4; 95% CI, 1.02-1.8) were independently associated with poor outcome. Outside emergency department transfer was not significantly associated with secondary outcomes. CONCLUSION: These data suggest that in critically ill patients with stroke, transfer from outside emergency department is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/21596517/Association_between_out_of_hospital_emergency_department_transfer_and_poor_hospital_outcome_in_critically_ill_stroke_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(11)00080-3 DB - PRIME DP - Unbound Medicine ER -