Prolonged Stay of Stroke Patients in the Emergency Department May Lead to an Increased Risk of Complications, Poor Recovery, and Increased Mortality

Akhtar, Naveed; Kamran, Saadat; Singh, Rajvir; Cameron, Peter; Bourke, Paula; Khan, Raheel; Joseph, Sujatha; Santos, Mark; Deleu, Dirk; Own, Ahmed; Al-Yazeedi, Wafa; Butt, Adeel A.; Boulton, John; Shuaib, Ashfaq

doi:10.1016/j.jstrokecerebrovasdis.2015.10.018

Cited by 27 publications

(34 citation statements)

References 15 publications

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“…6–9 In our cohort the median time to stroke ward (5.8 hours) and NICU (3.7 hours) admission was relatively short as compared to other studies (range 4.5–20 hours) 5–7,9–11 minimizing the overall impact of the ED-LOS on outcome. We hypothesize that our findings reflect triage decisions with prioritized admission of most severely affected patients with greater likelihood for a poor outcome.…”

Section: Discussioncontrasting

confidence: 52%

“…Results have been conflicting: while some studies found an association between ED-LOS and outcome, 5–7 others did not. 8–10 These differences may in part relate to absent differentiation between ischemic and hemorrhagic stroke etiology, subsequent admission to a stroke ward versus intensive care unit, as well as differences between study settings including widely varying ED-LOS.…”

Section: Introductionmentioning

confidence: 99%

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Emergency Department Length of Stay and Outcome after Ischemic Stroke

Minaeian

Patel

Essa

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background Emergency department length-of-stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. Methods Retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n=325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin scale [mRS] score >2), respectively. Results The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n=160) versus neurointensive care unit (NICU; n=165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P<0.001), endovascular stroke therapy (P=0.001), and thrombolysis (P=0.021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P=0.048). On multivariable logistic regression, a greater admission NIHSS (P<0.001), worse pre-admission mRS (P=0.001), hemorrhagic conversion (P=0.041), and a shorter ED-LOS (P=0.016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P=0.049), endovascular stroke therapy (P=0.041), NICU admission (P=0.029), and evening shift presentation (P=0.035) were associated with a good 90-day outcome. Conclusions In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk for a poor functional outcome.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Emergency Department Length of Stay and Outcome after Ischemic Stroke

Minaeian

Patel

Essa

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…In patients with acute cerebrovascular accidents, ED overcrowding is associated with delay to CT scanning, and boarding of these patients is associated with increased mortality, complications, and poorer recovery [26,27]. Overcrowding increases delays to antibiotics in patients with pneumonia as well as febrile neonates [28,29].…”

Section: The Impact Of Overcrowding On Patient Carementioning

confidence: 99%

Overcrowding in the Emergency Department and Patient Safety

Jeanmonod¹,

Jeanmonod²

2018

Vignettes in Patient Safety - Volume 2

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Emergency department (ED) overcrowding is a recognized problem worldwide. This chapter reviews the scope of the problem, manifestations, repercussions, and potential solutions to this problem.Keywords: emergency department overcrowding, emergency department safety, emergency department systems, emergency department patient care, emergency department throughput, emergency department output A 68-year-old Case vignete

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“…[12][13][14][15][16] We know from robust crowding literature that prolonged length of stay in the ED leads to poor outcomes in elderly, stroke, and critically ill patients. [17][18][19][20][21] Treatment delays lead to increased morbidity and mortality. [22][23][24][25][26][27][28] As writing holding orders may reduce the ED length of stay, it has the potential to improve outcomes for ED patients.…”

Section: Againstmentioning

confidence: 99%