title: Impact of delayed transfer of critically ill stroke patients from the Emergency Department to the Neuro-ICU.
abstract: BACKGROUND
  We sought to determine the effect of emergency department length of stay (ED-LOS) on outcomes in stroke patients admitted to the Neurological Intensive Care Unit (NICU).
  
  
  METHODS
  We collected data on all patients who presented to the ED at a single center from 1st February 2005 to 31st May 2007 with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) within 12 h of symptom onset. Data collected included demographics, admission/discharge National Institutes of Health Stroke Scale (NIHSS), discharge modified Rankin Score (mRS), and total ED length of stay. The effect of ED-LOS on discharge mRS, discharge NIHSS, and hospital LOS was assessed by logistic regression. Poor outcome was defined as mRS > or =4 at discharge.
  
  
  RESULTS
  Of 519 patients presenting to the ED, 75 (15%) were critically ill and admitted to the NICU (mean age 65 +/- 14 years, 31% men, and 37% Hispanic). Admission diagnosis included AIS (49%), ICH (47%), TIA (1%), and others (3%). Median ED-LOS was 5 h (IQR 3-8 h) and median hospital LOS was 7 days (IQR 3-15 days). In multivariate analysis, predictors of poor outcome included admission ICH (OR, 2.1; 95% CI, 1.1-4.3), NIHSS > or =6 (OR, 6.4; 95% CI, 2.3-17.9), and ED-LOS > or =5 h (OR, 3.8; 95% CI, 1.6-8.8). There was no association between ED-LOS and discharge NIHSS among survivors or total hospital LOS.
  
  
  CONCLUSIONS
  Among critically ill stroke patients, ED-LOS > or =5 h before transfer to the NICU is independently associated with poor outcome at hospital discharge.
authors.affiliation: Division of Neurology and Critical Care Medicine, Department of Medicine, Robert Wood Johnson Medical School, UMDNJ, Camden, NJ 08103, USA. Rincon-fred@cooperhealth.edu
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Juan
authors.initials: J
authors.lastname: Rivolta
authors.forename: Joshua
authors.initials: J
authors.lastname: Stillman
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Randolph
authors.initials: R
authors.lastname: Marshall
authors.forename: Ji Y
authors.initials: JY
authors.lastname: Chong
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000628:therapy; D016638:Critical Illness / Q000628:therapy; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology*; D016896:Treatment Outcome