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Impact on patient outcome of emergency department length of stay prior to ICU admission.
Med Intensiva. 2017 May; 41(4):201-208.MI

Abstract

OBJECTIVE

The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department.

DESIGN

A single-center ambispective cohort study was carried out.

SETTING

A general ICU and Emergency Care Department (ED) of a single University Hospital.

PATIENTS

We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period.

INTERVENTIONS

Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h.

VARIABLES

Demographic, diagnostic, length of stay and mortality data were compared among the groups.

RESULTS

Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p<0.01). A total of 129 patients (48%) had ED LOS >5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay.

CONCLUSIONS

A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support.

Authors+Show Affiliations

Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain. Electronic address: rennygg@hotmail.com.Servicio de Cirugía General, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.Servicio de Epidemiología e Investigación Clínica, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.Jefe del Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng spa

PubMed ID

27553889

Citation

García-Gigorro, R, et al. "Impact On Patient Outcome of Emergency Department Length of Stay Prior to ICU Admission." Medicina Intensiva, vol. 41, no. 4, 2017, pp. 201-208.
García-Gigorro R, de la Cruz Vigo F, Andrés-Esteban EM, et al. Impact on patient outcome of emergency department length of stay prior to ICU admission. Med Intensiva. 2017;41(4):201-208.
García-Gigorro, R., de la Cruz Vigo, F., Andrés-Esteban, E. M., Chacón-Alves, S., Morales Varas, G., Sánchez-Izquierdo, J. A., & Montejo González, J. C. (2017). Impact on patient outcome of emergency department length of stay prior to ICU admission. Medicina Intensiva, 41(4), 201-208. https://doi.org/10.1016/j.medin.2016.05.008
García-Gigorro R, et al. Impact On Patient Outcome of Emergency Department Length of Stay Prior to ICU Admission. Med Intensiva. 2017;41(4):201-208. PubMed PMID: 27553889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact on patient outcome of emergency department length of stay prior to ICU admission. AU - García-Gigorro,R, AU - de la Cruz Vigo,F, AU - Andrés-Esteban,E M, AU - Chacón-Alves,S, AU - Morales Varas,G, AU - Sánchez-Izquierdo,J A, AU - Montejo González,J C, Y1 - 2016/08/21/ PY - 2016/04/12/received PY - 2016/05/29/revised PY - 2016/05/31/accepted PY - 2016/8/25/pubmed PY - 2018/4/10/medline PY - 2016/8/25/entrez KW - Complicación dependiente del tiempo KW - Critical care KW - Cuidados intensivos KW - Emergency department KW - Servicio de urgencias KW - Time-dependent complication SP - 201 EP - 208 JF - Medicina intensiva JO - Med Intensiva VL - 41 IS - 4 N2 - OBJECTIVE: The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department. DESIGN: A single-center ambispective cohort study was carried out. SETTING: A general ICU and Emergency Care Department (ED) of a single University Hospital. PATIENTS: We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period. INTERVENTIONS: Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h. VARIABLES: Demographic, diagnostic, length of stay and mortality data were compared among the groups. RESULTS: Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p<0.01). A total of 129 patients (48%) had ED LOS >5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay. CONCLUSIONS: A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support. SN - 1578-6749 UR - https://www.unboundmedicine.com/medline/citation/27553889/Impact_on_patient_outcome_of_emergency_department_length_of_stay_prior_to_ICU_admission_ L2 - http://www.elsevier.es/en/linksolver/ft/pii/S0210-5691(16)30104-8 DB - PRIME DP - Unbound Medicine ER -