title: The impact of `admit no bed` and long boarding times in the emergency department on stroke outcome.
abstract: OBJECTIVE
  To examine and test the possible association between boarding time and stroke patients` outcome.
  
  
  METHODS
  This study is a retrospective review of stroke patients presenting to the Emergency Department (ED) of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time (BT) was defined as time of arrival to ward minus time of decision to admit. Primary outcome (PO) was defined as a composite of mortality, and/or any of post-stroke complications.
  
  
  RESULTS
  We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO (odds ratio [OR]=0.9, p=0.3), or any of the secondary outcomes, such as, death (OR=0.97, p=0.5), severe disability (OR=0.97, p=0.3), pneumonia (OR=1, p=0.9), urinary tract infection (OR=1, p=0.9), or neurological deterioration (OR=0.8, p=0.1). Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure (HF), onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome.
  
  
  CONCLUSIONS
  Although `admit no bed` was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged.
authors.affiliation: Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences/King Abdullah International Medical Research Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail. neuroahmad@yahoo.com.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Al-Khathaami
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Abulaban
authors.forename: Gamal E
authors.initials: GE
authors.lastname: Mohamed
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Alamry
authors.forename: Suleiman M
authors.initials: SM
authors.lastname: Kojan
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Aljumah
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012529:Saudi Arabia; D020521:Stroke / Q000473:pathology*; D013997:Time Factors