Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Nov;47(11):1564-1571.
doi: 10.1097/CCM.0000000000003957.

Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in The Netherlands

Carline N L Groenland  1 , Fabian Termorshuizen  2   3 , Wim J R Rietdijk  1 , Judith van den Brule  4 , Dave A Dongelmans  5 , Evert de Jonge  6 , Dylan W de Lange  7 , Anne Marie G A de Smet  8 , Nicolette F de Keizer  2   3 , Joachim D Weigel  1 , Lucia S D Jewbali  1   9 , Eric Boersma  9 , Corstiaan A den Uil  1   9
Affiliations
Observational Study

Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in The Netherlands

Carline N L Groenland et al. Crit Care Med. 2019 Nov.

Abstract

Objectives: Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality.

Design, setting, and patients: We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality.

Interventions: None.

Measurements and main results: A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3-3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p < 0.002), in particular in patients with the highest Acute Physiology and Chronic Health Evaluation IV probability and long emergency department to ICU time quintiles: odds ratio, 1.29; 95% CI, 1.02-1.64 (2.4-3.7 hr) and odds ratio, 1.54; 95% CI, 1.11-2.14 (> 3.7 hr), both compared with the reference category (< 1.2 hr). For 30-day and 90-day mortality, we found similar results. However, emergency department to ICU time was not correlated to adjusted ICU mortality (p = 0.20).

Conclusions: Prolonged emergency department to ICU time (> 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Odds ratios (ORs) for hospital mortality per length of stay in the emergency department. A, Emergency department to ICU time (ED to ICU time); adjusted for hospitals. B, ED to ICU time; adjusted for hospitals and Acute Physiology and Chronic Health Evaluation IV probability. The p values represent whether ED to ICU time as a whole is associated to hospital mortality. For the individual odds ratios and 95% CIs, we refer the reader to Table 2 model A and B under hospital mortality.
Figure 2.
Figure 2.
Odds ratios (ORs) for hospital mortality per length of stay in the emergency department plotted for each Acute Physiology and Chronic Health Evaluation (APACHE) IV probability quantile. A, Association between emergency department to ICU time (ED to ICU time) and APACHE IV probability less than 10.5%. B, Association between ED to ICU time and APACHE IV probability 10.5–25.6%. C, Association between ED to ICU time and APACHE IV probability 25.7–60.9%. D, Association between ED to ICU time and APACHE IV probability greater than 60.9%. The p values represent whether ED to ICU time as a whole is associated to hospital mortality. For the individual odds ratios and 95% CIs, we refer the reader to Table 2 model C under hospital mortality.
See this image and copyright information in PMC

Comment in

References

    1. Sprung CL, Danis M, Iapichino G, et al. Triage of intensive care patients: Identifying agreement and controversy. Intensive Care Med 2013; 39:1916–1924 - PMC - PubMed
    1. Garrouste-Orgeas M, Montuclard L, Timsit JF, et al. Triaging patients to the ICU: A pilot study of factors influencing admission decisions and patient outcomes. Intensive Care Med 2003; 29:774–781 - PubMed
    1. Rivers EP, Nguyen HB, Huang DT, et al. Critical care and emergency medicine. Curr Opin Crit Care 2002; 8:600–606 - PubMed
    1. Cosby KS. A framework for classifying factors that contribute to error in the emergency department. Ann Emerg Med 2003; 42:815–823 - PubMed
    1. Goldhill DR, McNarry AF, Hadjianastassiou VG, et al. The longer patients are in hospital before intensive care admission the higher their mortality. Intensive Care Med 2004; 30:1908–1913 - PubMed

Publication types

MeSH terms