Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU

Fred Rincon, Stephan A. Mayer, Juan Rivolta, Joshua Stillman, Bernadette Boden-Albala, Mitchell S V Elkind, Randolph Marshall, Ji Y. Chong

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)75-81
Number of pages7
JournalNeurocritical Care
Volume13
Issue number1
DOIs
StatePublished - Aug 2010

Keywords

  • Acute ischemic stroke
  • Emergency medicine
  • Hospital bed capacity
  • Neurocritical care
  • Resource utilization

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Rincon, F., Mayer, S. A., Rivolta, J., Stillman, J., Boden-Albala, B., Elkind, M. S. V., Marshall, R., & Chong, J. Y. (2010). Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU. Neurocritical Care, 13(1), 75-81. https://doi.org/10.1007/s12028-010-9347-0