Does prolonged length of stay in the emergency department affect outcome for stroke patients?

Minal Jain, Dushyant Damania, Anunaya R. Jain, Abhijit R. Kanthala, Latha Ganti, Babak S. Jahromi*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA). Methods: This was a retrospective review of adult patients with a discharge diagnosis of AIS/TIA presenting to an ED between July 2009 and February 2010. We collected demographics, EDLOS, arrival stroke severity (National Institutes of Health Stroke Scale - NIHSS), intravenous tissue plasminogen activator (IV tPA) use, functional outcome at discharge, discharge destination and hospital-LOS. We analyzed relationship between EDLOS, outcomes and discharge destination after controlling for confounders. Results: 190 patients were included in the cohort. Median EDLOS was 332 minutes (Inter-Quartile Range -IQR: 250.3-557.8). There was a significant inverse linear association between EDLOS and hospital-LOS (p=0.049). Patients who received IV tPA had a shorter median EDLOS (238 minutes, IQR: 194-299) than patients who did not (median: 387 minutes, IQR: 285-588 minutes; p<0.0001). There was no significant association between EDLOS and poor outcome (p=0.40), discharge destination (p=0.20), or death (p=0.44). This remained true even after controlling for IV tPA use, NIHSS and hospital-LOS; and did not change even when analysis was restricted to AIS patients alone. Conclusion: There was no significant association between prolonged EDLOS and outcome for AIS/ TIA patients at our institution. We therefore suggest that EDLOS alone is an insufficient indicator of stroke care in the ED, and that the ED can provide appropriate acute care for AIS/TIA patients.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalWestern Journal of Emergency Medicine
Volume15
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Hospital Emergency Service
Length of Stay
Stroke
Transient Ischemic Attack
Tissue Plasminogen Activator
Critical Illness
National Institutes of Health (U.S.)
Demography

Keywords

  • Emergency medicine
  • Length of stay
  • Mortality
  • Outcome
  • Stroke

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Jain, Minal ; Damania, Dushyant ; Jain, Anunaya R. ; Kanthala, Abhijit R. ; Ganti, Latha ; Jahromi, Babak S. / Does prolonged length of stay in the emergency department affect outcome for stroke patients?. In: Western Journal of Emergency Medicine. 2014 ; Vol. 15, No. 3. pp. 267-275.
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title = "Does prolonged length of stay in the emergency department affect outcome for stroke patients?",
abstract = "Introduction: Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA). Methods: This was a retrospective review of adult patients with a discharge diagnosis of AIS/TIA presenting to an ED between July 2009 and February 2010. We collected demographics, EDLOS, arrival stroke severity (National Institutes of Health Stroke Scale - NIHSS), intravenous tissue plasminogen activator (IV tPA) use, functional outcome at discharge, discharge destination and hospital-LOS. We analyzed relationship between EDLOS, outcomes and discharge destination after controlling for confounders. Results: 190 patients were included in the cohort. Median EDLOS was 332 minutes (Inter-Quartile Range -IQR: 250.3-557.8). There was a significant inverse linear association between EDLOS and hospital-LOS (p=0.049). Patients who received IV tPA had a shorter median EDLOS (238 minutes, IQR: 194-299) than patients who did not (median: 387 minutes, IQR: 285-588 minutes; p<0.0001). There was no significant association between EDLOS and poor outcome (p=0.40), discharge destination (p=0.20), or death (p=0.44). This remained true even after controlling for IV tPA use, NIHSS and hospital-LOS; and did not change even when analysis was restricted to AIS patients alone. Conclusion: There was no significant association between prolonged EDLOS and outcome for AIS/ TIA patients at our institution. We therefore suggest that EDLOS alone is an insufficient indicator of stroke care in the ED, and that the ED can provide appropriate acute care for AIS/TIA patients.",
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Does prolonged length of stay in the emergency department affect outcome for stroke patients? / Jain, Minal; Damania, Dushyant; Jain, Anunaya R.; Kanthala, Abhijit R.; Ganti, Latha; Jahromi, Babak S.

In: Western Journal of Emergency Medicine, Vol. 15, No. 3, 2014, p. 267-275.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does prolonged length of stay in the emergency department affect outcome for stroke patients?

AU - Jain, Minal

AU - Damania, Dushyant

AU - Jain, Anunaya R.

AU - Kanthala, Abhijit R.

AU - Ganti, Latha

AU - Jahromi, Babak S.

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N2 - Introduction: Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA). Methods: This was a retrospective review of adult patients with a discharge diagnosis of AIS/TIA presenting to an ED between July 2009 and February 2010. We collected demographics, EDLOS, arrival stroke severity (National Institutes of Health Stroke Scale - NIHSS), intravenous tissue plasminogen activator (IV tPA) use, functional outcome at discharge, discharge destination and hospital-LOS. We analyzed relationship between EDLOS, outcomes and discharge destination after controlling for confounders. Results: 190 patients were included in the cohort. Median EDLOS was 332 minutes (Inter-Quartile Range -IQR: 250.3-557.8). There was a significant inverse linear association between EDLOS and hospital-LOS (p=0.049). Patients who received IV tPA had a shorter median EDLOS (238 minutes, IQR: 194-299) than patients who did not (median: 387 minutes, IQR: 285-588 minutes; p<0.0001). There was no significant association between EDLOS and poor outcome (p=0.40), discharge destination (p=0.20), or death (p=0.44). This remained true even after controlling for IV tPA use, NIHSS and hospital-LOS; and did not change even when analysis was restricted to AIS patients alone. Conclusion: There was no significant association between prolonged EDLOS and outcome for AIS/ TIA patients at our institution. We therefore suggest that EDLOS alone is an insufficient indicator of stroke care in the ED, and that the ED can provide appropriate acute care for AIS/TIA patients.

AB - Introduction: Conflicting data exist regarding the association between the length of stay (LOS) of critically ill patients in the emergency department (ED) and their subsequent outcome. However, such patients are an overall heterogeneous group, and we therefore sought to study the association between EDLOS and outcomes in a specific subgroup of critically ill patients, namely those with acute ischemic stroke/transient ischemic attack (AIS/TIA). Methods: This was a retrospective review of adult patients with a discharge diagnosis of AIS/TIA presenting to an ED between July 2009 and February 2010. We collected demographics, EDLOS, arrival stroke severity (National Institutes of Health Stroke Scale - NIHSS), intravenous tissue plasminogen activator (IV tPA) use, functional outcome at discharge, discharge destination and hospital-LOS. We analyzed relationship between EDLOS, outcomes and discharge destination after controlling for confounders. Results: 190 patients were included in the cohort. Median EDLOS was 332 minutes (Inter-Quartile Range -IQR: 250.3-557.8). There was a significant inverse linear association between EDLOS and hospital-LOS (p=0.049). Patients who received IV tPA had a shorter median EDLOS (238 minutes, IQR: 194-299) than patients who did not (median: 387 minutes, IQR: 285-588 minutes; p<0.0001). There was no significant association between EDLOS and poor outcome (p=0.40), discharge destination (p=0.20), or death (p=0.44). This remained true even after controlling for IV tPA use, NIHSS and hospital-LOS; and did not change even when analysis was restricted to AIS patients alone. Conclusion: There was no significant association between prolonged EDLOS and outcome for AIS/ TIA patients at our institution. We therefore suggest that EDLOS alone is an insufficient indicator of stroke care in the ED, and that the ED can provide appropriate acute care for AIS/TIA patients.

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KW - Length of stay

KW - Mortality

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KW - Stroke

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