title: Prolonged emergency department length of stay is not associated with worse outcomes in patients with intracerebral hemorrhage.
abstract: BACKGROUND
  Prolonged emergency department length of stay (EDLOS) has been associated with worse patient outcomes, longer inpatient stays, and failure to meet quality measures in several acute medical conditions, but these findings have not been consistently reproduced. We performed this study to explore the hypothesis that longer EDLOS would be associated with worse outcomes in a large cohort of patients presenting with spontaneous intracerebral hemorrhage (ICH).
  
  
  METHODS
  We performed a secondary analysis of a prospective cohort of consecutive patients with spontaneous ICH who presented to a single academic referral center from February 2005 to October 2009. The primary exposure variable was EDLOS, and our primary outcome was neurologic status at hospital discharge, measured with a modified Rankin scale (mRS). Secondary outcomes were ICU length of stay, total hospital length of stay, and total hospital costs.
  
  
  RESULTS
  Our cohort included 616 visits of which 42 were excluded, leaving 574 patient encounters for analysis. Median age was 75 years (IQR 63-82), median EDLOS 5.1 h (IQR 3.7-7.1) and median discharge mRS 4 (IQR 3-6). Thirty percent of the subjects died in-hospital. Multivariable proportional odds logistic regression, controlling for age, initial Glasgow Coma Scale, initial hematoma volume, ED occupancy at registration, and the need for intubation or surgical intervention, demonstrated no association between EDLOS and outcome. Furthermore, multivariable analysis revealed no association of increased EDLOS with ICU or hospital length of stay or hospital costs.
  
  
  CONCLUSIONS
  We found no effect of EDLOS on neurologic outcome or resource utilization for patients presenting with spontaneous ICH.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. jelmer@partners.org
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elmer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.forename: Shan
authors.initials: S
authors.lastname: Liu
authors.forename: Catherine
authors.initials: C
authors.lastname: Pearson
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies