Emergency Department Length of Stay and Outcome after Ischemic Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 10; pp. 2167 - 2173
• Main Authors: Minaeian, Artin, MD, Patel, Anand, MD, Essa, Basad, MD, Goddeau, Richard P., DO, Moonis, Majaz, MD, Henninger, Nils, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Cardiovascular; Cerebral Hemorrhage - physiopathology; Cerebral Hemorrhage - therapy; Disease Progression; emergency department; Emergency Medical Services; Emergency Service, Hospital; Endovascular Procedures; Female; functional outcome; Humans; Intensive Care Units; Ischemic stroke; Length of Stay; Linear Models; Logistic Models; Male; Multivariate Analysis; Neurology; Patient Admission; Retrospective Studies; Stroke - physiopathology; Stroke - therapy; Thrombolytic Therapy; Treatment Outcome; length of stay; functional outcome; Ischemic stroke; emergency department
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.040

Background Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. Methods This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively. Results The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission ( P  <   .001), endovascular stroke therapy ( P  = .001), and thrombolysis ( P  = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS ( P  = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score ( P  <   .001), worse preadmission mRS score ( P  = .001), hemorrhagic conversion ( P  = .041), and a shorter ED-LOS ( P  = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy ( P  = .049), endovascular stroke therapy ( P  = .041), NICU admission ( P  = .029), and evening shift presentation ( P  = .035) were associated with a good 90-day outcome. Conclusions In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.