Impact of delayed transfer of critically ill stroke patients from the Emergency Department to the Neuro-ICU.
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.
Rincon
Fred
F
Division of Neurology and Critical Care Medicine, Department of Medicine, Robert Wood Johnson Medical School, UMDNJ, Camden, NJ 08103, USA. Rincon-fred@cooperhealth.edu
Mayer
Stephan A
SA
Rivolta
Juan
J
Stillman
Joshua
J
Boden-Albala
Bernadette
B
Elkind
Mitchell S V
MS
Marshall
Randolph
R
Chong
Ji Y
JY
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