title: Delayed emergency department presentation in critically ill patients.
abstract: OBJECTIVE
  To determine the frequency and causes of delayed emergency department presentation in critically ill patients who did not have acute myocardial infarction and to evaluate whether factors such as age, gender, prior medical advice, lack of insurance, or low educational level are associated with delayed presentation.
  
  
  METHODS
  Prospective, descriptive analysis.
  
  
  METHODS
  Emergency department and medical intensive care unit of an urban county hospital.
  
  
  METHODS
  All adult patients admitted from the emergency department to the medical intensive care unit for reasons other than unstable angina, acute myocardial infarction, or stroke over two 9-wk blocks.
  
  
  METHODS
  Within 72 hrs of intensive care unit admission, patients or their families were interviewed to determine time elapsed between the onset of symptoms and patient emergency department presentation and to elicit reasons for delays in seeking medical treatment.
  
  
  RESULTS
  We interviewed 155 of 173 (90%) of eligible patients and found that 58% waited >24 hrs before presenting to the emergency department. The most commonly cited primary reason for delays were beliefs that symptoms were not serious enough for emergency care (31%) and that symptoms would resolve spontaneously (29%). Most (55%) sought medical treatment only at the urging of family members or other advocates. Although variables such as lack of insurance and low educational level were not associated with delayed presentation, male gender and having sought medical advice before presenting to the emergency department were significantly associated with delay (p =.036 for each).
  
  
  CONCLUSIONS
  Because of poor understanding of the gravity and natural progression of their symptoms, most critically ill patients waited >24 hrs to present to our emergency department. Education on warning symptom recognition for serious illnesses may be warranted not only for patients themselves but also for family members and caregivers.
authors.affiliation: Department of Emergency Medicine, Highland General Hospital, Oakland, CA, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Rodriguez
authors.forename: M
authors.initials: M
authors.lastname: Passanante
authors.forename: M A
authors.initials: MA
authors.lastname: Phelps
authors.forename: G
authors.initials: G
authors.lastname: Dresden
authors.forename: K
authors.initials: K
authors.lastname: Kriza
authors.forename: M
authors.initials: M
authors.lastname: Carrasco
authors.forename: J
authors.initials: J
authors.lastname: Franklin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006766:Hospitals, County; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors