Impact of delayed transfer of critically ill stroke patients from the Emergency Department to the Neuro-ICU

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 > or =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 > or =6 (OR, 6.4; 95% CI, 2.3-17.9), and ED-LOS > or =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 > or =5 h before transfer to the NICU is independently associated with poor outcome at hospital discharge.