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Original article
Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission
  1. Zhongheng Zhang1,
  2. Faran Bokhari2,
  3. Yizhan Guo3,
  4. Hemant Goyal4
  1. 1Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
  2. 2Department of Trauma/Burns/Critical Care, Stroger Hospital of Cook County, Rush Medical College, Chicago, Illinois, USA
  3. 3Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
  4. 4Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA
  1. Correspondence to Dr Zhongheng Zhang, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; zh_zhang1984{at}zju.edu.cn

Abstract

Background and objectives Delayed patient admission to the intensive care unit (ICU) from the ED is common in China. Patients with severe sepsis or septic shock requiring ICU admission are in need of specialised monitoring and tailored treatment. Delayed admission to the ICU might be associated with adverse clinical outcomes for patients with sepsis.

Methods Patients with sepsis admitted to the ICU from the ED from January 2010 to April 2018 were retrospectively identified from a clinical data warehouse. The primary endpoint was in-hospital mortality. Length of stay in ED (EDLOS) was compared between survivors and non-survivors. A multivariable regression model was employed to adjust for potential confounding due to patient clinical condition.

Results A total of 1997 patients, including 473 non-survivors and 1524 survivors, were included. The crude mortality rate for patients with EDLOS <6 hours was 21.4%, which was significantly lower than patients with EDLOS of 12–24 hours (31.9%), and those with EDLOS >24 hours (31.8%). After adjusting for PaO2/FiO2, serum creatinine, age, Sequential Organ Failure Assessment, body mass index, lactate, comorbidities and infection site, EDLOS continued to be independently associated with increased risk of hospital mortality. Compared with the group with EDLOS <6 hours, those with EDLOS between 12and24 hours (OR 1.82, 95% CI 1.28 to 2.58) and EDLOS >24 hours (OR 1.79, 95% CI 1.27 to 2.52) showed a significantly increased risk of death.

Conclusions Our study shows that prolonged EDLOS is independently associated with increased risk of hospital mortality in patients with sepsis requiring ICU admission.

  • clinical care
  • crowding
  • emergency care systems

https://doi.org/10.1136/emermed-2018-208032

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors ZZ conceived the study. ZZ and YG carried out data entry, data check and interpretation. ZZ performed statistical analysis and drafted the manuscript. FB and HG helped review and interpret the results. All authors read and approved the final manuscript.

    • Funding ZZ received funding from the Public Welfare Research Project of Zhejiang Province (LGF18H150005) and the scientific research project of Zhejiang Education Commission (Y201737841).

    • Competing interests None declared.

    • Ethics approval The study was approved by the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.