title: Impact on patient outcome of emergency department length of stay prior to ICU admission.
abstract: OBJECTIVE
  The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department.
  
  
  METHODS
  A single-center ambispective cohort study was carried out.
  
  
  METHODS
  A general ICU and Emergency Care Department (ED) of a single University Hospital.
  
  
  METHODS
  We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period.
  
  
  METHODS
  Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h.
  
  
  METHODS
  Demographic, diagnostic, length of stay and mortality data were compared among the groups.
  
  
  RESULTS
  Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p<0.01). A total of 129 patients (48%) had ED LOS >5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay.
  
  
  CONCLUSIONS
  A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain. Electronic address: rennygg@hotmail.com.
authors.forename: R
authors.initials: R
authors.lastname: García-Gigorro
authors.affiliation: Servicio de Cirugía General, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: de la Cruz Vigo
authors.affiliation: Servicio de Epidemiología e Investigación Clínica, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: E M
authors.initials: EM
authors.lastname: Andrés-Esteban
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Chacón-Alves
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Morales Varas
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Sánchez-Izquierdo
authors.affiliation: Jefe del Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, 28041 Madrid, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Montejo González
mesh_terms: D000368:Aged; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013030:Spain; D016896:Treatment Outcome
keywords: Complicación dependiente del tiempo; Critical care; Cuidados intensivos; Emergency department; Servicio de urgencias; Time-dependent complication