van Herwerden Michael C, Groenland Carline N L, Termorshuizen Fabian, Rietdijk Wim J R, Blokzijl Fredrike, Cleffken Berry I, Dormans Tom, Epker Jelle L, Feyz Lida, Gritters van den Oever Niels, van der Heiden Pim, de Jonge Evert, Latten Gideon H P, Pruijsten Ralph V, Sir Özcan, Spronk Peter E, Vermeijden Wytze J, van Vliet Peter, de Keizer Nicolette F, den Uil Corstiaan A
Department of Intensive Care Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Crit Care Med. 2024 Dec 1;52(12):1856-1865. doi: 10.1097/CCM.0000000000006396. Epub 2024 Aug 19.
This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.
DESIGN, SETTING, AND PATIENTS: We conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores.
None.
A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2-3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability ( p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORs adjApache ) was 1.24 (95% CI, 1.00-1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORs adjApache for ED-to-ICU times of 1.6-2.3, 2.3-3.4, and greater than 3.4 hours were 1.21 (1.01-1.46), 1.21 (1.00-1.46), and 1.34 (1.10-1.64), respectively. In NACT hospitals, no association was observed ( p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORs adjED ). In the academic hospitals the ORs adjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81-1.19), no overall association was observed ( p = 0.08). In NACT hospitals, all time-ascending quintiles had ORs adjED values of less than 1.0 ( p < 0.01).
In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.
本研究旨在通过学术性和非学术性教学（NACT）医院对患者进行分层，并考虑急性生理学与慢性健康状况评估（APACHE）-IV概率和急诊分诊评分，从而深入了解急诊科（ED）到重症监护病房（ICU）的时间对医院死亡率的影响。
设计、地点和患者：我们使用荷兰国家重症监护评估登记处的数据进行了一项回顾性队列研究（2009 - 2020年）。从四家学术性医院和八家NACT医院纳入了直接从急诊科转入ICU的患者。使用多变量回归估计与ED到ICU时间相关的死亡率的比值比（OR），包括粗比值比以及在根据APACHE-IV概率和急诊分诊评分进行调整和分层之后的比值比。
无。
共纳入28455例患者。ED到ICU的中位时间为1.9小时（四分位间距，1.2 - 3.1小时）。在根据APACHE-IV概率进行调整后，未观察到ED到ICU时间与医院死亡率之间的总体关联（p = 0.36）。对于APACHE-IV概率大于55.4%（最高五分位数）且ED到ICU时间大于3.4小时的患者，与参考类别（< 1.1小时）相比，调整后的OR（ORs adjApache）为1.24（95% CI，1.00 - 1.54；p < 0.05）。在学术性医院中，ED到ICU时间为1.6 - 2.3小时、2.3 - 3.4小时以及大于3.4小时的ORs adjApache分别为1.21（1.01 - 1.46）、1.21（1.00 - 1.46）和1.34（1.10 - 1.64）。在NACT医院中，未观察到关联（p = 0.07）。随后，根据急诊分诊评分对OR进行调整（ORs adjED）。在学术性医院中，ED到ICU时间大于3.4小时的ORs adjED为0.98（0.81 - 1.19），未观察到总体关联（p = 0.08）。在NACT医院中，所有时间递增的五分位数的ORs adjED值均小于1.0（p < 0.01）。
在学术性医院中APACHE-IV概率最高的患者中，延长的ED到ICU时间与医院死亡率增加相关。在APACHE-IV概率较低的组和NACT医院中，我们未发现显著或一致的不利关联。在根据急诊分诊评分进行调整和分层后，未发现较长的ED到ICU时间与较高死亡率之间的关联。
