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Emergency department length of stay in critical nonoperative trauma.
J Surg Res. 2017 06 15; 214:102-108.JS

Abstract

BACKGROUND

Prolonged emergency department (ED) stays correlate with negative outcomes in critically ill nontrauma patients. This study sought to determine the effect of ED length of stay (LOS) on trauma patients.

MATERIALS AND METHODS

Two hundred forty-one trauma patients requiring direct intensive care unit (ICU) admission were identified. Patients requiring immediate operative intervention were excluded. Odds ratios (ORs) of outcomes for patients transferred to ICU in ≤90 min were compared with patients transferred in >90 min, adjusting for Injury Severity Score (ISS).

RESULTS

One hundred two of 241 patients (42%) were transferred to the ICU in ≤90 min. Increased ED LOS was associated with decreased complications (OR 0.545, 95% confidence interval 0.312-0.952). Although the result was not statistically significant, patients with an ISS >15 were less likely to have long ED stays (OR 0.725, 95% CI 0.407-1.290). No significant difference was seen in mortality. No difference in duration of intubation was observed for patients intubated in the ED versus the ICU. For the subgroup with ISS ≤15, there was a significant decrease in ICU LOS for patients who remained in the ED >90 min (5.5 d versus 2.7 d, P = 0.02). No other differences in LOS were identified.

CONCLUSIONS

In a mature trauma center with standardized activation protocols and focused resource allocation in the ED trauma bay, trauma activation and subsequent management appear to mitigate the negative effects of prolonged ED LOS seen in other critically ill populations.

Authors+Show Affiliations

Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: aeastoak-siletz@mednet.ucla.edu.Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: acheaito@mednet.ucla.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28624030

Citation

Siletz, Anaar, et al. "Emergency Department Length of Stay in Critical Nonoperative Trauma." The Journal of Surgical Research, vol. 214, 2017, pp. 102-108.
Siletz A, Jin K, Cohen M, et al. Emergency department length of stay in critical nonoperative trauma. J Surg Res. 2017;214:102-108.
Siletz, A., Jin, K., Cohen, M., Lewis, C., Tillou, A., Cryer, H. M., & Cheaito, A. (2017). Emergency department length of stay in critical nonoperative trauma. The Journal of Surgical Research, 214, 102-108. https://doi.org/10.1016/j.jss.2017.02.079
Siletz A, et al. Emergency Department Length of Stay in Critical Nonoperative Trauma. J Surg Res. 2017 06 15;214:102-108. PubMed PMID: 28624030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency department length of stay in critical nonoperative trauma. AU - Siletz,Anaar, AU - Jin,Kexin, AU - Cohen,Marilyn, AU - Lewis,Catherine, AU - Tillou,Areti, AU - Cryer,Henry Magill, AU - Cheaito,Ali, Y1 - 2017/03/08/ PY - 2016/12/03/received PY - 2017/02/20/revised PY - 2017/02/28/accepted PY - 2017/6/19/entrez PY - 2017/6/19/pubmed PY - 2017/9/20/medline KW - Critical care KW - Emergency department length of stay KW - Trauma SP - 102 EP - 108 JF - The Journal of surgical research JO - J Surg Res VL - 214 N2 - BACKGROUND: Prolonged emergency department (ED) stays correlate with negative outcomes in critically ill nontrauma patients. This study sought to determine the effect of ED length of stay (LOS) on trauma patients. MATERIALS AND METHODS: Two hundred forty-one trauma patients requiring direct intensive care unit (ICU) admission were identified. Patients requiring immediate operative intervention were excluded. Odds ratios (ORs) of outcomes for patients transferred to ICU in ≤90 min were compared with patients transferred in >90 min, adjusting for Injury Severity Score (ISS). RESULTS: One hundred two of 241 patients (42%) were transferred to the ICU in ≤90 min. Increased ED LOS was associated with decreased complications (OR 0.545, 95% confidence interval 0.312-0.952). Although the result was not statistically significant, patients with an ISS >15 were less likely to have long ED stays (OR 0.725, 95% CI 0.407-1.290). No significant difference was seen in mortality. No difference in duration of intubation was observed for patients intubated in the ED versus the ICU. For the subgroup with ISS ≤15, there was a significant decrease in ICU LOS for patients who remained in the ED >90 min (5.5 d versus 2.7 d, P = 0.02). No other differences in LOS were identified. CONCLUSIONS: In a mature trauma center with standardized activation protocols and focused resource allocation in the ED trauma bay, trauma activation and subsequent management appear to mitigate the negative effects of prolonged ED LOS seen in other critically ill populations. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/28624030/Emergency_department_length_of_stay_in_critical_nonoperative_trauma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(17)30129-4 DB - PRIME DP - Unbound Medicine ER -