Akhtar Naveed, Kamran Saadat, Singh Rajvir, Cameron Peter, Bourke Paula, Khan Rabia, Joseph Sujatha, Santos Mark, Deleu Dirk, Own Ahmed, Al-Yazeedi Wafa, Butt Adeel Ajwad, Boulton John, Shuaib Ashfaq
The Neuroscience Institute, Stroke Center of Excellence, Hamad Medical Corporation, Doha, Qatar.
Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar.
J Stroke Cerebrovasc Dis. 2016 Mar;25(3):672-8. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.018. Epub 2015 Dec 31.
Following an acute stroke (AS), patients are at an increased risk of developing complications that may affect prognosis. With overcrowding in the emergency department (ED), patients stay longer hours to days before transfer to a proper stroke ward. The aim of this study was to evaluate the effect of increasing length of stay (LOS) in the ED on the risk of stroke-related complications.
We analyzed data from our stroke registry of patients admitted with AS during 2014. Stay in ED was divided into 2 groups: less than 8 hours and more than 8 hours. Data regarding demographics, stroke type, severity of stroke, ED (LOS) in hours, total LOS in hospital, number and types of complications, and prognosis were collected.
Mean age was 54.8 years and 78.9% were males (total n = 894). Prior to ward admission, 265 (29.5%) patients remained in the ED for less than 8 hours and 629 (70.4%) remained for more than 8 hours. There was no significant difference in comorbidities or the severity of stroke at admission between the 2 groups. An ED LOS of less than 8 hours was associated with reduced risk of complications (14.3% versus 19.2%, P = .06), reduced LOS in hospital, better prognosis at discharge (72.5% versus 57.6% had modified Rankin Scale of ≤2, P = .001) and at 90 days (89% versus 78.8%, P = .007) and lower in-hospital mortality (1.5% versus 5.4 %, P = .004).
Delays in transferring AS patients from the ED may lead to an increase in complications resulting in an increased LOS and slower recovery.
急性卒中（AS）后，患者发生可能影响预后的并发症的风险增加。由于急诊科（ED）拥挤，患者在转至合适的卒中病房之前需停留数小时至数天。本研究的目的是评估急诊科住院时间（LOS）延长对卒中相关并发症风险的影响。
我们分析了2014年期间因AS入院的患者的卒中登记数据。在急诊科的停留时间分为两组：少于8小时和多于8小时。收集了有关人口统计学、卒中类型、卒中严重程度、急诊科停留时间（以小时计）、住院总时间、并发症的数量和类型以及预后的数据。
平均年龄为54.8岁，男性占78.9%（总数n = 894）。在病房入院前，265例（29.5%）患者在急诊科停留少于8小时，629例（70.4%）患者停留多于8小时。两组入院时的合并症或卒中严重程度无显著差异。急诊科停留时间少于8小时与并发症风险降低相关（14.3%对19.2%，P = 0.06），住院时间缩短，出院时（改良Rankin量表≤2的患者为72.5%对57.6%，P = 0.001）和90天时预后更好（89%对78.8%，P = 0.007），院内死亡率更低（1.5%对5.4%，P = 0.004）。
将AS患者从急诊科转出的延迟可能导致并发症增加，从而导致住院时间延长和恢复缓慢。
