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Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage


Affiliations
1 Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, United States
2 Department of Neurology, Columbia University, New York, NY, United States
3 Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, United States
4 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
5 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
 

Objectives: Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods: Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08-6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results: Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4-6 (OR 3.638, 95% CI 1.531-8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491-6.236, and P = 0.0023) but not death. Conclusions: Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.
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  • Prolonged Emergency Department Length of Stay as a Predictor of Adverse Outcomes in Patients with Intracranial Hemorrhage

Abstract Views: 45  |  PDF Views: 1

Authors

Erica M. Jones
Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, United States
Amelia K. Boehme
Department of Neurology, Columbia University, New York, NY, United States
Aimee Aysenne
Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, United States
Tiffany Chang
Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, United States
Karen C. Albright
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
Christopher Burns
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
T. Mark Beasley
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
Sheryl Martin-Schild
Comprehensive Stroke Center, Department of Neurology, Tulane University, New Orleans, LA, United States

Abstract


Objectives: Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH). Methods: Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08-6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival. Results: Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4-6 (OR 3.638, 95% CI 1.531-8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491-6.236, and P = 0.0023) but not death. Conclusions: Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.