Emergency Department to ICU Time Is Associated With Hospital Mortality: A Registry Analysis of 14,788 Patients From Six University Hospitals in the Netherlands
Groenland, Carline N.L.; Termorshuizen, Fabian; Rietdijk, Wim J.R.; Van Den Brule, Judith; Dongelmans, Dave A.; De Jonge, Evert; De Lange, Dylan W.; De Smet, Anne Marie G.A.; De Keizer, Nicolette F.; Weigel, Joachim D.; Jewbali, Lucia S.D.; Boersma, Eric; Den Uil, Corstiaan A.
(2019) Critical Care Medicine, volume 47, issue 11, pp. 1564 - 1571
(Article)
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
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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, 1.3-3.3hr). 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 (2.4-3.7hr) and odds ratio, 1.54; 95% CI, 1.11-2.14 (> 3.7hr), both compared with the reference category (< 1.2hr). 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 (> 2.4hr) 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.
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Keywords: critically ill, emergency department, intensive care unit, length of stay, mortality, Critically ill, Critical Care and Intensive Care Medicine, Journal Article
ISSN: 0090-3493
Publisher: Lippincott Williams and Wilkins
Note: Funding Information: Drs. Termorshuizen’s and de Keizer’s institutions received funding from National Intensive Care Evaluation registry, and they received funding from Amsterdam UMC. Dr. Termorshuizen received funding from Mental Health Care Institute, GGZ Rivierduinen and Utrecht University, Utrecht Institute for Pharmaceutical Sciences. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: c.groenland@erasmusmc.nl Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Publisher Copyright: © 2019 Lippincott Williams and Wilkins. All rights reserved.
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