Effect of Delayed Admission to Intensive Care Units from the Emergency Department on the Mortality of Critically Ill Patients

Abstract

Background: Increasing in emergency department need to critical care, the number of intensive care unit bed worldwide is inadequate to meet these applies. Objectives: The aim of this study was to investigate the effect of waiting for admission to the Intensive Care Unit (ICU) in the Emergency Department (ED) on the length of stay in the ICU and the mortality of critically ill patients. Methods: This retrospective cohort study carried out between January 2012 - 2019 patients admitted to the ICU of a training and research hospital. The data of 1297 adult patients were obtained by searching the Clinical Decision Support System. Results: The data of the patients were evaluated in two groups as those considered to be delayed and non-delayed. It was determined that the delay of two hours increased the risk of mortality 1.5 times. Hazard Ratios (HR) was 1.548 (1.077 - 2.224). Patients whose ICU admission was delayed by 5 - 6 hours were found to have the highest risk in terms of mortality (HR = 2.291 [1.503 - 3.493]). A statistically significant difference was found in the ICU mortality, 28-day and, 90-day mortality between the two groups. ICU mortality for all patients’ general was 25.2% (327/1297). This rate was 11.4% (55/481) in the non-delayed group and 33.3% (272/816) in the delayed group (P < 0.001). The 28-day mortality rate for all patients’ general was 26.9% (349/1297). This rate was found to be 13.5% (65/481) in the non-delayed group and 34.8% (284/816) in the delayed group (P < 0.001). The 90-day mortality for all patients’ general was 28.4% (368/1297). This rate was 14.1% (68/481) in the non-delayed group and 36.8% (300/816) in the delayed group (P < 0.001). Conclusions: Prolonged stay in the ED before admission to the ICU is associated with worse consequences, and increased mortality.

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

“…Thirty-three of these were included in the MA (Table 3) [25][26][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48][49][50][57][58][59][60][61]63,68,71]. The remaining 17 studies [3,9,37,[51][52][53][54][55][56]62,[64][65][66][67]69,70,72] were excluded for one of the following reasons:…”

“…(1) the specific EDLOS cut-off was not defined [3,9,37,[51][52][53][54]56,62,[64][65][66][67]69,72]; (2) one study reported data in severely ill mechanically ventilated patients [54]; and (3) raw data were missing in one study [70]. We subsequently acquired the original databases for four studies [34,41,42,45], which allowed us to perform analysis of nine different EDLOS cut-off values: 1.2 h [34,41,42,45,50], 1.5 h [34,[40][41][42]45], 2 h [32,34,41,42,45], 3 h [34,41,42,45,47,68], 4 h [33,[40][41][42]44,57,58], 5 h…”

“…The Netherlands [50], France [64], Norway [65]), 15 in North America (USA [9,30,32,33,35,36,38,40,46,55,58,60,68,72], Canada [3]), 15 in Asia (Qatar [29], Saudi Arabia [61], China [31,44,55,66], Thailand [41], India [42,72], Pakistan [48,63], Israel [57], Iran [70], South Korea [59], Turkey [69]), 7 in Australia [25][26][27][28]43,51,67], and 2 in Latin America [52,56]. The characteristics of the selected studies are listed in Tables 1 and 2.…”

“…Thirty studies examined patients who were transferred from the ED to the ICU [3,25,32,[34][35][36][38][39][40]42,44,45,47,48,[50][51][52][53][54][55][56][58][59][60][61]63,67,[69][70][71]. Twenty studies examined patients who were not admitted to the ICU, but were admitted to non-ICU wards [9,[26][27][28][29][30][31]33,37,41,43,46,49,57,62,[64][65][66]68,72].…”

Determinants of Mortality of Patients Admitted to the Intensive Care Unit at Debre Berhan Comprehensive Specialized Hospital: A Retrospective Cohort Study

“…Other studies conducted in Brazil, Taiwan, United Kingdom, Turkey, and other systematic reviews and meta-analysis also showed a similar association between ICU mortality and delayed admissions. [20][21][22][23][24] Patients with a Glasgow Coma Scale (GCS) score of less than 8 had an approximately fourfold higher likelihood of ICU mortality compared with patients with a GCS score of greater than or equal to 13 (adjusted odds ratio = 3.9732, 95% confidence interval: 2.1249-7.4290). Similar associations between GCS and ICU mortality were also observed in studies conducted in USA, Kenya, and Ethiopia.…”