Prognostic Signficace Of Emergency Department Length Of Stay In Patients With Acute Cerebral Infarction

Objective:Stroke is one of the most common critical diseases in the emergency department,and conflicting data exist regarding the association between emergency department length of stay(EDLOS)and the functional outcome in stoke patients.The effect of EDLOS on outcomes of patients with acute cerebral infarction remains largely unexamined.Here,we aimed to investigate the relationship between EDLOS with stroke progression and outcomes in patients with acute cerebral infarction.Methods:In this cross-sectional cohort study,a total of 618 patients with acute cerebral infarction who were admitted to the emergency department of the Second Affiliated Hospital of Suzhou University between January 2017 and December 2017,including the green channel of stroke,were included consecutively.Baseline demographics,stroke risk factors,ED admission information and relevant information during hospitalization were collected and recorded.Patients with acute cerebral infarction were scored by the National Institutes of Health Stroke Scale(NIHSS)to assess neurological impairment,and use Modified Rankin scale(mRS)to evaluate the self-care ability of patients in daily life for 30 days after discharge.Stroke progression was defined as any time point increment in NIHSS over 2 points within 7d after onset or any new neurological deficit and poor prognosis was defined as modified Rankin Scale(mRS)scores>2 at 30d.Statistical analysis was performed using SPSS 22.0 software.Comparison was performed using an ANOVA test,Kruskal-Wallis test,or the chi-square test where appropriate.We performed multivariable linear regression to assess the predictors of EDLOS.Using Logistic regression model to analyze the relationship between EDLOS and stroke progression,prognosis and death at 30 days after discharge in patients with acute cerebral infarction.Results:The average age of 618 patients with acute cerebral infarction was 67.5 years,and the median EDLOS was 2.5 hours(1.4-6.9h).On multivariable linear regression,transferring to stroke unit(P=0.013),receiving endovascular interventional treatment(P=0.030),and holiday visit(P<0.001)were associated with shorter EDLOS,whereas admission between September and November(P=0.009)was associated with a longer EDLOS.The EDLOS of the progressive group was shorter than that of the non-progressive group,with median values of 2.2 hours and 2.6 hours,respectively.There was a significant difference between the two groups(P=0.005).There was a significant difference in EDLOS between the death group and survival group.EDLOS were 1.8 hours and 2.5 hours in death and survival group,respectively(P=0.018).Patients with poor prognosis had a shorter median EDLOS than those with good prognosis,the median EDLOS were 2.4 hours and 2.6 hours,respectively,but this difference was not statistically significant(P=0.093).Patients were categorized into four groups according to EDLOS quartiles:EDLOS?1.35h,1.35-2.49h,2.49-6.93h,and>6.93h.There was significant difference in stroke progression and death at 30 days between the four groups(P<0.05),while there was no significant difference in poor prognosis at 30 days.After adjusting for potential confounders,patients with the lowest EDLOS(?1.35h)were 2-3 fold more likely to have stroke progression,compared with those with the highest EDLOS(>6.93h)(OR,2.52;95%CI,1.29-4.93;P=0.043).In the single-factor logistic analysis,there was a significant association between EDLOS and death at 30d(P=0.032),however,in the multivariate analysis,no significant association was found(P=0.165).After adjusting for confounding factors,we did not find any statistically significant association between EDLOS and stroke prognosis at 30 days after discharge(P=0.719).A higher admission NIHSS score(P<0.001)and complications(P<0.001)were associated with a poor 30-day outcome.Conclusion:In patients with acute cerebral infarction,shorter EDLOS was associated with the increased risk of stroke progression,which may be related to our emergency admission strategy of prioritizing the transfer of critical patients with a higher risk of stroke progression to wards.In our comprehensive stroke center,there was no significant association between EDLOS and prognosis at 30 day after discharge for patients with acute cerebral infarction,and EDLOS alone might be an insufficient indicator of stroke care in the ED.