Qian Junwei, Yuan Yinuo, Shang Zhaoming, Zhou Kangshuai, Lu Qiuxin, Zhou Lingyu, Zhou Wenzhen, Jiang Xiaofei, Chen Mingquan
Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Department of Emergency Medicine, Huashan Hospital, Fudan University, Shanghai, China
BMJ Open. 2025 Apr 5;15(4):e090011. doi: 10.1136/bmjopen-2024-090011.
The association between the duration from the emergency department (ED) to the intensive care units (ICUs) and in-hospital mortality among patients admitted directly to the ICUs from the ED remains controversial. This study aimed to use data from the Medical Information Mart for Intensive Care-IV database to explore the relationship between the ED to ICUs time and patient outcomes.
Retrospective observational study.
Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019.
A total of 15 246 adult patients were identified as admitted directly from the ED to the ICUs during their first hospitalisation. After excluding those without recorded ED registration times and those with a hospital-to-ICU admission interval exceeding 6 hours (n=2432), the final analysis cohort comprised 12 703 patients.
The primary outcome was in-hospital all-cause mortality. Secondary outcomes included 28-day all-cause mortality and length of stay in ICU and hospital.
The median ED to ICUs time was 3.98 hours. Longer ED to ICUs times were associated with lower in-hospital mortality, decreasing from 17.6% in the shortest to 12.2% in the longest interval group, and shorter ICU stays. After propensity score weighting, adjusted logistic regression models confirmed the inverse association between longer ED to ICUs time and in-hospital mortality (OR: 0.75, 95% CI: 0.69 to 0.82, p<0.01). Restricted cubic spline analysis showed a non-linear decline in mortality risk with increasing ED to ICUs time, with a sharper reduction after 5.65 hours. Kaplan-Meier curves indicated consistently better survival in the longest interval group (p<0.01). Sensitivity analysis, reintroducing patients with hospital to ICUs times over 6 hours, confirmed the robustness of these results.
Longer ED to ICUs time is linked to lower mortality and shorter ICU length of stay, suggesting that appropriately extending ED stays may benefit critically ill patients.
从急诊科（ED）到重症监护病房（ICU）的时长与直接从ED收治入ICU的患者院内死亡率之间的关联仍存在争议。本研究旨在利用重症监护医学信息数据库-IV（Medical Information Mart for Intensive Care-IV database）的数据，探讨ED到ICU的时间与患者预后之间的关系。
回顾性观察性研究。
2008年至2019年贝斯以色列女执事医疗中心重症监护病房的收治情况。
共有15246例成年患者在首次住院期间被确定为直接从ED收治入ICU。在排除那些没有记录ED登记时间的患者以及医院到ICU入院间隔超过6小时的患者（n = 2432）后，最终分析队列包括12703例患者。
主要结局是院内全因死亡率。次要结局包括28天全因死亡率以及在ICU和医院的住院时长。
ED到ICU的中位时间为3.98小时。ED到ICU的时间越长，院内死亡率越低，从最短间隔组的17.6%降至最长间隔组的12.2%，且ICU住院时间更短。在倾向评分加权后，校正逻辑回归模型证实了ED到ICU时间越长与院内死亡率之间的负相关（比值比：0.75，95%置信区间：0.69至0.82，p<0.01）。受限立方样条分析显示，随着ED到ICU时间的增加，死亡风险呈非线性下降，在5.65小时后下降更为明显。Kaplan-Meier曲线表明，最长间隔组的生存情况始终更好（p<0.01）。敏感性分析重新纳入了医院到ICU时间超过6小时的患者，证实了这些结果的稳健性。
ED到ICU的时间越长，死亡率越低，ICU住院时长越短，这表明适当延长在ED的停留时间可能对危重症患者有益。
