Puls Henrique A, Haas Nathan L, Cranford James A, Medlin Richard P, Bassin Benjamin S
Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA.
Division of Critical Care, Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA.
J Am Coll Emerg Physicians Open. 2022 Feb 21;3(1):e12684. doi: 10.1002/emp2.12684. eCollection 2022 Feb.
Emergency department (ED) boarding of patients who are critically ill is associated with poor outcomes. ED-based intensive care units (ED-ICUs) may mitigate the risks of ED boarding. We sought to analyze the impact of ED length of stay (LOS) before transfer to an ED-ICU on patient outcomes.
We retrospectively analyzed adult ED patients managed in the ED-ICU at a US medical center. Bivariate and multivariable linear regressions tested ED LOS as a predictor of inpatient ICU and hospital LOS, and separate bivariate and multivariable logistic regressions tested ED LOS as a predictor of inpatient ICU admission, 48-hour mortality, and hospital mortality. Multivariable analyses' covariates were age, sex, Charlson Comorbidity Index (CCI), Emergency Severity Index, and eSimplified Acute Physiology Score (eSAPS3).
We included 5859 ED visits with subsequent care in the ED-ICU. Median age, CCI, eSAPS3, ED LOS, and ED-ICU LOS were 62 years (interquartile range [IQR], 48-73 years), 5 (IQR, 2-8), 46 (IQR, 36-56), 3.6 hours (IQR, 2.5-5.3 hours), and 8.5 hours (IQR, 5.3-13.4 hours), respectively, and 46.3% were women. Bivariate analyses showed negative associations of ED LOS with hospital LOS (β -3.4; 95% confidence interval [CI], -5.9 to -1.0), inpatient ICU admission (odds ratio [OR], 0.86, 95% CI, 0.84-0.88), 48-hour mortality (OR, 0.89; 95% CI, 0.82-0.98), and hospital mortality (OR, 0.89; 95% CI, 0.85-0.92), but no association with inpatient ICU LOS. Multivariable analyses showed a negative association of ED LOS with inpatient ICU admission (OR, 0.91; 95% CI, 0.88-0.93), but no associations with other outcomes.
We observed no significant associations between ED LOS before ED-ICU transfer and worsened outcomes, suggesting an ED-ICU may mitigate the risks of ED boarding of patients who are critically ill.
危重病患者在急诊科（ED）留观与不良预后相关。基于急诊科的重症监护病房（ED-ICU）可能会降低急诊科留观的风险。我们试图分析转至ED-ICU之前在急诊科的住院时间（LOS）对患者预后的影响。
我们回顾性分析了美国一家医疗中心在ED-ICU接受治疗的成年急诊科患者。双变量和多变量线性回归检验了急诊科住院时间作为住院重症监护病房和医院住院时间预测指标的情况，单独的双变量和多变量逻辑回归检验了急诊科住院时间作为住院重症监护病房入住、48小时死亡率和医院死亡率预测指标的情况。多变量分析的协变量包括年龄、性别、查尔森合并症指数（CCI）、急诊严重程度指数和简化急性生理学评分（eSAPS3）。
我们纳入了5859例在ED-ICU接受后续治疗的急诊科就诊病例。中位年龄、CCI、eSAPS3、急诊科住院时间和ED-ICU住院时间分别为62岁（四分位间距[IQR]，48 - 73岁）、5（IQR，2 - 8）、46（IQR，36 - 56）、3.6小时（IQR，2.5 - 5.3小时）和8.5小时（IQR，5.3 - 13.4小时），女性占46.3%。双变量分析显示，急诊科住院时间与医院住院时间（β -3.4；95%置信区间[CI]，-5.9至-1.0）、住院重症监护病房入住（比值比[OR]，0.86，95% CI，0.84 - 0.88）、48小时死亡率（OR，0.89；95% CI，0.82 - 0.98）和医院死亡率（OR，0.89；95% CI，0.85 - 0.92）呈负相关，但与住院重症监护病房住院时间无关。多变量分析显示，急诊科住院时间与住院重症监护病房入住呈负相关（OR，0.91；95% CI，0.88 - 0.93），但与其他预后指标无关。
我们观察到在转至ED-ICU之前的急诊科住院时间与预后恶化之间无显著关联，这表明ED-ICU可能会降低危重病患者在急诊科留观的风险。
