TY - JOUR
T1 - Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU
AU - Rincon, Fred
AU - Mayer, Stephan A.
AU - Rivolta, Juan
AU - Stillman, Joshua
AU - Boden-Albala, Bernadette
AU - Elkind, Mitchell S V
AU - Marshall, Randolph
AU - Chong, Ji Y.
N1 - Funding Information:
Acknowledgments This paper was supported by grants NINDS/ NIH P50 NS049060 (SPOTRIAS). Dr. Rincon was a SPOTRIAS Fellow.
PY - 2010/8
Y1 - 2010/8
N2 - Background: We sought to determine the effect of emergency department length of stay (ED-LOS) on outcomes in stroke patients admitted to the Neurological Intensive Care Unit (NICU). Methods: We collected data on all patients who presented to the ED at a single center from 1st February 2005 to 31st May 2007 with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) within 12 h of symptom onset. Data collected included demographics, admission/discharge National Institutes of Health Stroke Scale (NIHSS), discharge modified Rankin Score (mRS), and total ED length of stay. The effect of ED-LOS on discharge mRS, discharge NIHSS, and hospital LOS was assessed by logistic regression. Poor outcome was defined as mRS ≥4 at discharge. Results: Of 519 patients presenting to the ED, 75 (15%) were critically ill and admitted to the NICU (mean age 65 ± 14 years, 31% men, and 37% Hispanic). Admission diagnosis included AIS (49%), ICH (47%), TIA (1%), and others (3%). Median ED-LOS was 5 h (IQR 3-8 h) and median hospital LOS was 7 days (IQR 3-15 days). In multivariate analysis, predictors of poor outcome included admission ICH (OR, 2.1; 95% CI, 1.1-4.3), NIHSS ≥6 (OR, 6.4; 95% CI, 2.3-17.9), and ED-LOS ≥5 h (OR, 3.8; 95% CI, 1.6-8.8). There was no association between ED-LOS and discharge NIHSS among survivors or total hospital LOS. Conclusion: Among critically ill stroke patients, ED-LOS ≥5 h before transfer to the NICU is independently associated with poor outcome at hospital discharge.
AB - Background: We sought to determine the effect of emergency department length of stay (ED-LOS) on outcomes in stroke patients admitted to the Neurological Intensive Care Unit (NICU). Methods: We collected data on all patients who presented to the ED at a single center from 1st February 2005 to 31st May 2007 with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) within 12 h of symptom onset. Data collected included demographics, admission/discharge National Institutes of Health Stroke Scale (NIHSS), discharge modified Rankin Score (mRS), and total ED length of stay. The effect of ED-LOS on discharge mRS, discharge NIHSS, and hospital LOS was assessed by logistic regression. Poor outcome was defined as mRS ≥4 at discharge. Results: Of 519 patients presenting to the ED, 75 (15%) were critically ill and admitted to the NICU (mean age 65 ± 14 years, 31% men, and 37% Hispanic). Admission diagnosis included AIS (49%), ICH (47%), TIA (1%), and others (3%). Median ED-LOS was 5 h (IQR 3-8 h) and median hospital LOS was 7 days (IQR 3-15 days). In multivariate analysis, predictors of poor outcome included admission ICH (OR, 2.1; 95% CI, 1.1-4.3), NIHSS ≥6 (OR, 6.4; 95% CI, 2.3-17.9), and ED-LOS ≥5 h (OR, 3.8; 95% CI, 1.6-8.8). There was no association between ED-LOS and discharge NIHSS among survivors or total hospital LOS. Conclusion: Among critically ill stroke patients, ED-LOS ≥5 h before transfer to the NICU is independently associated with poor outcome at hospital discharge.
KW - Acute ischemic stroke
KW - Emergency medicine
KW - Hospital bed capacity
KW - Neurocritical care
KW - Resource utilization
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U2 - 10.1007/s12028-010-9347-0
DO - 10.1007/s12028-010-9347-0
M3 - Article
C2 - 20428969
AN - SCOPUS:77954384689
SN - 1541-6933
VL - 13
SP - 75
EP - 81
JO - Neurocritical Care
JF - Neurocritical Care
IS - 1
ER -