title: Prolonged emergency department length of stay is not associated with worse outcomes in traumatic brain injury.
abstract: BACKGROUND
  Data suggest that prolonged Emergency Department length of stay (EDLOS) has a detrimental effect on outcomes in some critically ill patients. However, the relationship between EDLOS and outcomes in traumatic brain injury (TBI) has not been examined.
  
  
  OBJECTIVE
  Our objective was to determine the effect of EDLOS on neurologic outcomes in TBI patients.
  
  
  METHODS
  We performed a retrospective analysis of a prospectively identified cohort of patients with moderate (Glasgow Coma Scale [GCS] score 9-13) and severe (GCS ≤ 8) TBI who presented to a Level 1 trauma center (2006-2010). Inclusion criteria were transfer to the intensive care unit (ICU) or operating room (OR) from the ED. Primary outcome was Glasgow Outcome Scale (GOS) score, a measure of neurologic function, at discharge. We used a proportional odds model to control for significant predictors of GOS in univariate analysis.
  
  
  RESULTS
  Two hundred and twenty-four patients were included in the analysis, 77 (34%) of which were transferred to the OR. Median EDLOS was 3.3 h and 81.2% of patients had a GOS score ≤3 (e.g., severe disability, vegetative, or deceased). In multivariable analyses, EDLOS was not associated with GOS score in either ICU bound (p = 0.57) or OR bound (p = 0.11) patients. Younger age, pupil reactivity, and absence of intubation were independent predictors of good outcomes in the ICU group. In OR patients, predictors of higher GOS score included presence of an epidural hemorrhage, absence of midline shift, and pupil reactivity.
  
  
  CONCLUSIONS
  Our study demonstrates that EDLOS was not associated with poor outcomes in patients with moderate to severe TBI who required intensive care or early operative intervention in an academic Level 1 trauma center.
authors.affiliation: Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Ali Y
authors.initials: AY
authors.lastname: Mejaddam
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elmer
authors.forename: Antonios C
authors.initials: AC
authors.lastname: Sideris
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Laurie
authors.initials: L
authors.lastname: Petrovick
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagenholz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000601:surgery; D004636:Emergency Service, Hospital; D005260:Female; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data*; D006407:Hematoma, Epidural, Cranial / Q000601:surgery; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011379:Prognosis; D012025:Reflex, Pupillary; D012189:Retrospective Studies; D055815:Young Adult
keywords: Emergency Department; Glasgow Outcome Scale; length of stay; mortality; traumatic brain injury