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Impact of Delayed Transfer of Critically Ill Stroke Patients from the Emergency Department to the Neuro-ICU

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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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Acknowledgments

This paper was supported by grants NINDS/NIH P50 NS049060 (SPOTRIAS). Dr. Rincon was a SPOTRIAS Fellow.

Conflict of interest statement

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Division of Neurology and Critical Care Medicine, Department of Medicine, Robert Wood Johnson Medical School, UMDNJ, 401 Haddon Ave., Rm. 242, Camden, NJ, 08103, USA

    Fred Rincon

  2. Division of Stroke and Neurocritical Care, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10034, USA

    Stephan A. Mayer, Juan Rivolta, Bernadette Boden-Albala, Mitchell S. V. Elkind, Randolph Marshall & Ji Y. Chong

  3. Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10034, USA

    Joshua Stillman

  4. Department of Sociomedical Science, Mailman School of Public Health, Columbia University, New York, NY, 10034, USA

    Bernadette Boden-Albala

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  1. Fred Rincon
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  2. Stephan A. Mayer
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  3. Juan Rivolta
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  4. Joshua Stillman
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  5. Bernadette Boden-Albala
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  6. Mitchell S. V. Elkind
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  7. Randolph Marshall
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  8. Ji Y. Chong
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Correspondence to Fred Rincon.

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Rincon, F., Mayer, S.A., Rivolta, J. et al. Impact of Delayed Transfer of Critically Ill Stroke Patients from the Emergency Department to the Neuro-ICU. Neurocrit Care 13, 75–81 (2010). https://doi.org/10.1007/s12028-010-9347-0

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  • DOI: https://doi.org/10.1007/s12028-010-9347-0

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