title: Does prolonged length of stay in the emergency department affect outcome for stroke patients?
abstract: BACKGROUND
  Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA).
  
  
  METHODS
  This was a retrospective review of adult patients with a discharge diagnosis of AIS/TIA presenting to an ED between July 2009 and February 2010. We collected demographics, EDLOS, arrival stroke severity (National Institutes of Health Stroke Scale - NIHSS), intravenous tissue plasminogen activator (IV tPA) use, functional outcome at discharge, discharge destination and hospital-LOS. We analyzed relationship between EDLOS, outcomes and discharge destination after controlling for confounders.
  
  
  RESULTS
  190 patients were included in the cohort. Median EDLOS was 332 minutes (Inter-Quartile Range -IQR: 250.3-557.8). There was a significant inverse linear association between EDLOS and hospital-LOS (p=0.049). Patients who received IV tPA had a shorter median EDLOS (238 minutes, IQR: 194-299) than patients who did not (median: 387 minutes, IQR: 285-588 minutes; p<0.0001). There was no significant association between EDLOS and poor outcome (p=0.40), discharge destination (p=0.20), or death (p=0.44). This remained true even after controlling for IV tPA use, NIHSS and hospital-LOS; and did not change even when analysis was restricted to AIS patients alone.
  
  
  CONCLUSIONS
  There was no significant association between prolonged EDLOS and outcome for AIS/TIA patients at our institution. We therefore suggest that EDLOS alone is an insufficient indicator of stroke care in the ED, and that the ED can provide appropriate acute care for AIS/TIA patients. [West J Emerg Med. 2014;15(3):267-275.].
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Minal
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Dushyant
authors.initials: D
authors.lastname: Damania
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Anunaya R
authors.initials: AR
authors.lastname: Jain
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Abhijit R
authors.initials: AR
authors.lastname: Kanthala
authors.affiliation: Departments of Emergency Medicine and Neurological Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Latha
authors.initials: L
authors.lastname: Ganti
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Babak S
authors.initials: BS
authors.lastname: Jahromi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000503:physiopathology*; 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; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000503:physiopathology*; D014481:United States