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

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Critical Illness
Hospital Emergency Service
Stroke
Length of Stay
National Institutes of Health (U.S.)
Cerebral Hemorrhage
Intensive Care Units
Transient Ischemic Attack
Hispanic Americans
Survivors
Multivariate Analysis
Logistic Models
Demography

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
  • Medicine(all)

Cite this

Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU. / Rincon, Fred; Mayer, Stephan A.; Rivolta, Juan; Stillman, Joshua; Boden-Albala, Bernadette; Elkind, Mitchell S V; Marshall, Randolph; Chong, Ji Y.

In: Neurocritical Care, Vol. 13, No. 1, 08.2010, p. 75-81.

Research output: Contribution to journalArticle

Rincon, F, Mayer, SA, Rivolta, J, Stillman, J, Boden-Albala, B, Elkind, MSV, Marshall, R & Chong, JY 2010, 'Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU', Neurocritical Care, vol. 13, no. 1, pp. 75-81. https://doi.org/10.1007/s12028-010-9347-0
Rincon, Fred ; Mayer, Stephan A. ; Rivolta, Juan ; Stillman, Joshua ; Boden-Albala, Bernadette ; Elkind, Mitchell S V ; Marshall, Randolph ; Chong, Ji Y. / Impact of delayed transfer of critically Ill stroke patients from the emergency department to the Neuro-ICU. In: Neurocritical Care. 2010 ; Vol. 13, No. 1. pp. 75-81.
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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.",
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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.

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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.

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KW - Neurocritical care

KW - Resource utilization

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