Artin Minaeian1, Anand Patel1, Basad Essa1, Richard P Goddeau1, Majaz Moonis1, Nils Henninger2. 1. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts. 2. Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: nils.henninger@umassmed.edu.
Abstract
BACKGROUND: Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic stroke patients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. METHODS: This study is a retrospective analysis of a single-center cohort of consecutive ischemic stroke patients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively. RESULTS: The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P <.001), endovascular stroke therapy (P = .001), and thrombolysis (P = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score (P <.001), worse preadmission mRS score (P = .001), hemorrhagic conversion (P = .041), and a shorter ED-LOS (P = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P = .049), endovascular stroke therapy (P = .041), NICU admission (P = .029), and evening shift presentation (P = .035) were associated with a good 90-day outcome. CONCLUSIONS: In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.
BACKGROUND: Emergency department length of stay (ED-LOS) has been associated with worse outcomes after various medical conditions. However, there is a relative paucity of data for ischemic strokepatients. We sought to determine whether a longer ED-LOS is associated with a poor 90-day outcome after ischemic stroke. METHODS: This study is a retrospective analysis of a single-center cohort of consecutive ischemic strokepatients (n = 325). Multivariable linear and logistic regression models were constructed to determine factors independently associated with ED-LOS as well as a poor 90-day outcome (modified Rankin Scale [mRS] score >2), respectively. RESULTS: The median ED-LOS in the cohort was 5.8 hours. For patients admitted to the inpatient stroke ward (n = 160) versus the neuroscience intensive care unit (NICU; n = 165), the median ED-LOS was 8.2 hours versus 3.7 hours, respectively. On multivariable linear regression, NICU admission (P <.001), endovascular stroke therapy (P = .001), and thrombolysis (P = .021) were inversely associated with the ED-LOS. Evening shift presentation was associated with a longer ED-LOS (P = .048). On multivariable logistic regression, a greater admission National Institutes of Health Stroke Scale score (P <.001), worse preadmission mRS score (P = .001), hemorrhagic conversion (P = .041), and a shorter ED-LOS (P = .016) were associated with a poor 90-day outcome. Early initiation of statin therapy (P = .049), endovascular stroke therapy (P = .041), NICU admission (P = .029), and evening shift presentation (P = .035) were associated with a good 90-day outcome. CONCLUSIONS: In contrast to prior studies, a shorter ED-LOS was associated with a worse 90-day functional outcome, possibly reflecting prioritized admission of more severely affected patients who are at high risk of a poor functional outcome.
Authors: Jonathan Elmer; Daniel J Pallin; Shan Liu; Catherine Pearson; Yuchiao Chang; Carlos A Camargo; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: Neurocrit Care Date: 2012-12 Impact factor: 3.210
Authors: J Claude Hemphill; Steven M Greenberg; Craig S Anderson; Kyra Becker; Bernard R Bendok; Mary Cushman; Gordon L Fung; Joshua N Goldstein; R Loch Macdonald; Pamela H Mitchell; Phillip A Scott; Magdy H Selim; Daniel Woo Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Donald B Chalfin; Stephen Trzeciak; Antonios Likourezos; Brigitte M Baumann; R Phillip Dellinger Journal: Crit Care Med Date: 2007-06 Impact factor: 7.598
Authors: Ali M Al-Khathaami; Ahmad A Abulaban; Gamal E Mohamed; Ahmed M Alamry; Suleiman M Kojan; Mohammed A Aljumah Journal: Saudi Med J Date: 2014-09 Impact factor: 1.484
Authors: Sarah Song; Gregg C Fonarow; DaiWai M Olson; Li Liang; Phillip J Schulte; Adrian F Hernandez; Eric D Peterson; Mathew J Reeves; Eric E Smith; Lee H Schwamm; Jeffrey L Saver Journal: Stroke Date: 2016-04-14 Impact factor: 7.914