Effective Triage Can Ameliorate the Deleterious Effects of Delayed Transfer of Trauma Patients from the Emergency Department to the ICU

Richardson, J. David; Franklin, Glen A.; Santos, Ariel; Harbrecht, Brian G.; Danzl, D F; Coleman, Royce; Smith, Jason W.; Miller, Frank B.; McMasters, Kelly M.

doi:10.1016/j.jamcollsurg.2008.11.018

Cited by 32 publications

(33 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results here for triage are similar to those of a previous study of trauma patients wherein triage results are associated with deleterious effects from the ED to the ICU [22]. …”

Section: Discussionsupporting

confidence: 86%

Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department

et al. 2014

View full text Add to dashboard Cite

IntroductionThe adverse effects of delayed admission to the intensive care unit (ICU) have been recognized in previous studies. However, the definitions of delayed admission vary across studies. This study proposed a model to define ‘delayed admission’, and explored the effect of ICU waiting time on patients’ outcome.MethodsThis retrospective cohort study included nontraumatic adult patients on mechanical ventilation in the emergency department (ED), from July 2009 to June 2010. The primary outcomes measures were 21-ventilator-day mortality and prolonged hospital stays (over 30 days). Models of Cox regression and logistic regression were used for multivariate analysis. The non-delayed ICU waiting was defined as a period in which the time effect on mortality was not statistically significant in a Cox regression model. To identify a suitable cutoff point between ‘delayed’ and ‘non-delayed’ subsets from the overall data were made based on ICU waiting time and the hazard ratio of ICU waiting hour in each subset was iteratively calculated. The cutoff time was then used to evaluate the impact of delayed ICU admission on mortality and prolonged length of hospital stay.ResultsThe final analysis included 1,242 patients. The time effect on mortality emerged after 4 hours, thus we deduced ICU waiting time in the ED of >4 hours as delayed. By logistic regression analysis, delayed ICU admission affected the outcomes of 21-ventilator-day mortality and prolonged hospital stay, with an odds ratio of 1.41 (95% confidence interval, 1.05 to 1.89) and 1.56 (95% confidence interval, 1.07 to 2.27) respectively.ConclusionsFor patients on mechanical ventilation in the ED, delayed ICU admission is associated with higher probability of mortality and additional resource expenditure. A benchmark waiting time of no more than 4 hours for ICU admission is recommended.

show abstract

“…The results here for triage are similar to those of a previous study of trauma patients wherein triage results are associated with deleterious effects from the ED to the ICU [22]. …”

Section: Discussionsupporting

confidence: 86%

Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department

et al. 2014

View full text Add to dashboard Cite

show abstract

“…A study conducted in a level I trauma centre showed that non-delayed group had significantly higher risk of death than delayed group (18% vs 2.3%). This might be explained by the fact that more severely ill trauma patients were transferred with priority without delay 23. In another study by Agustin et al , the authors found no difference in mortality outcome between patients with sepsis with and without prolonged ED stay 24.…”

Section: Discussionmentioning

confidence: 98%

Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

et al. 2018

View full text Add to dashboard Cite

Background and objectivesDelayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis.MethodsPatients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse. The primary endpoint was in-hospital mortality. Length of stay in ED (EDLOS) was compared between survivors and non-survivors. A multivariable regression model was employed to adjust for potential confounding due to patient clinical condition.ResultsA total of 1997 patients, including 473 non-survivors and 1524 survivors, were included. The crude mortality rate for patients with EDLOS <6 hours was 21.4%, which was significantly lower than patients with EDLOS of 12–24 hours (31.9%), and those with EDLOS >24 hours (31.8%). After adjusting for PaO2/FiO2, serum creatinine, age, Sequential Organ Failure Assessment, body mass index, lactate, comorbidities and infection site, EDLOS continued to be independently associated with increased risk of hospital mortality. Compared with the group with EDLOS <6 hours, those with EDLOS between 12and24 hours (OR 1.82, 95% CI 1.28 to 2.58) and EDLOS >24 hours (OR 1.79, 95% CI 1.27 to 2.52) showed a significantly increased risk of death.ConclusionsOur study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.

show abstract

“…The delivery of critical care is resource intensive, and previous data have suggested that prolonged ED LOS may be associated with negative health outcomes. 8,9,11 Richardson et al 18 published data that showed that aggressive triage can identify patients who need early transfer and that if transferred the adverse effects of prolonged ED LOS can be minimized. Caution should be used when examining their data as it does not condone an increased ED LOS in trauma patients but rather emphasizes that a mature trauma system can readily triage ill trauma patients into areas of care that can better meet the patient's needs.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

Mowery

Dougherty

Hildreth

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

View full text Add to dashboard Cite

show abstract

Effective Triage Can Ameliorate the Deleterious Effects of Delayed Transfer of Trauma Patients from the Emergency Department to the ICU

Cited by 32 publications

References 17 publications

Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department

Determining delayed admission to the intensive care unit for mechanically ventilated patients in the emergency department

Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

Contact Info

Product

Resources

About