title: Prolonged Stay of Stroke Patients in the Emergency Department May Lead to an Increased Risk of Complications, Poor Recovery, and Increased Mortality.
abstract: OBJECTIVE
  Following an acute stroke (AS), patients are at an increased risk of developing complications that may affect prognosis. With overcrowding in the emergency department (ED), patients stay longer hours to days before transfer to a proper stroke ward. The aim of this study was to evaluate the effect of increasing length of stay (LOS) in the ED on the risk of stroke-related complications.
  
  
  METHODS
  We analyzed data from our stroke registry of patients admitted with AS during 2014. Stay in ED was divided into 2 groups: less than 8 hours and more than 8 hours. Data regarding demographics, stroke type, severity of stroke, ED (LOS) in hours, total LOS in hospital, number and types of complications, and prognosis were collected.
  
  
  RESULTS
  Mean age was 54.8 years and 78.9% were males (total n = 894). Prior to ward admission, 265 (29.5%) patients remained in the ED for less than 8 hours and 629 (70.4%) remained for more than 8 hours. There was no significant difference in comorbidities or the severity of stroke at admission between the 2 groups. An ED LOS of less than 8 hours was associated with reduced risk of complications (14.3% versus 19.2%, P = .06), reduced LOS in hospital, better prognosis at discharge (72.5% versus 57.6% had modified Rankin Scale of ≤2, P = .001) and at 90 days (89% versus 78.8%, P = .007) and lower in-hospital mortality (1.5% versus 5.4 %, P = .004).
  
  
  CONCLUSIONS
  Delays in transferring AS patients from the ED may lead to an increase in complications resulting in an increased LOS and slower recovery.
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Naveed
authors.initials: N
authors.lastname: Akhtar
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Saadat
authors.initials: S
authors.lastname: Kamran
authors.affiliation: Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Paula
authors.initials: P
authors.lastname: Bourke
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Rabia
authors.initials: R
authors.lastname: Khan
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Joseph
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Mark
authors.initials: M
authors.lastname: Santos
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Dirk
authors.initials: D
authors.lastname: Deleu
authors.affiliation: Department of Radiology, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Own
authors.affiliation: Department of Rehabilitation Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Wafa
authors.initials: W
authors.lastname: Al-Yazeedi
authors.affiliation: Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Adeel Ajwad
authors.initials: AA
authors.lastname: Butt
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
authors.forename: John
authors.initials: J
authors.lastname: Boulton
authors.affiliation: The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar. Electronic address: ashuaib@hamad.qa.
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data*; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D016019:Survival Analysis
keywords: Stroke care; emergency ward; management of stroke; stroke prognosis; stroke ward