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Emergency Department to ICU Time Is Associated With Hospital Mortality

A Registry Analysis of 14,788 Patients From Six University Hospitals in the Netherlands

Groenland, Carline N. L. BSc1; Termorshuizen, Fabian PhD2,3; Rietdijk, Wim J. R. PhD1; van den Brule, Judith MD, PhD4; Dongelmans, Dave A. MD, PhD5; de Jonge, Evert MD, PhD6; de Lange, Dylan W. MD, PhD7; de Smet, Anne Marie G. A. MD, PhD8; de Keizer, Nicolette F. PhD2,3; Weigel, Joachim D. MD1; Jewbali, Lucia S. D. MD1,9; Boersma, Eric PhD9; den Uil, Corstiaan A. MD, PhD1,9

doi: 10.1097/CCM.0000000000003957
Clinical Investigation: PDF Only
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Objectives: Prolonged emergency department to ICU waiting time may delay intensive care treatment, which could negatively affect patient outcomes. The aim of this study was to investigate whether emergency department to ICU time is associated with hospital mortality.

Design, Setting, and Patients: We conducted a retrospective observational cohort study using data from the Dutch quality registry National Intensive Care Evaluation. Adult patients admitted to the ICU directly from the emergency department in six university hospitals, between 2009 and 2016, were included. Using a logistic regression model, we investigated the crude and adjusted (for disease severity; Acute Physiology and Chronic Health Evaluation IV probability) odds ratios of emergency department to ICU time on mortality. In addition, we assessed whether the Acute Physiology and Chronic Health Evaluation IV probability modified the effect of emergency department to ICU time on mortality. Secondary outcomes were ICU, 30-day, and 90-day mortality.

Interventions: None.

Measurements and Main Results: A total of 14,788 patients were included. The median emergency department to ICU time was 2.0 hours (interquartile range, 1.3–3.3 hr). Emergency department to ICU time was correlated to adjusted hospital mortality (p < 0.002), in particular in patients with the highest Acute Physiology and Chronic Health Evaluation IV probability and long emergency department to ICU time quintiles: odds ratio, 1.29; 95% CI, 1.02–1.64 (2.4–3.7 hr) and odds ratio, 1.54; 95% CI, 1.11–2.14 (> 3.7 hr), both compared with the reference category (< 1.2 hr). For 30-day and 90-day mortality, we found similar results. However, emergency department to ICU time was not correlated to adjusted ICU mortality (p = 0.20).

Conclusions: Prolonged emergency department to ICU time (> 2.4 hr) is associated with increased hospital mortality after ICU admission, mainly driven by patients who had a higher Acute Physiology and Chronic Health Evaluation IV probability. We hereby provide evidence that rapid admission of the most critically ill patients to the ICU might reduce hospital mortality.

1Department of Intensive Care Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

2Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands.

3National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands.

4Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.

5Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.

6Department of Intensive Care Medicine, University Medical Center Leiden, Leiden, The Netherlands.

7Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.

8Department of Intensive Care Medicine, University Medical Center Groningen, Groningen, The Netherlands.

9Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Drs. Termorshuizen’s and de Keizer’s institutions received funding from National Intensive Care Evaluation registry, and they received funding from Amsterdam UMC. Dr. Termorshuizen received funding from Mental Health Care Institute, GGZ Rivierduinen and Utrecht University, Utrecht Institute for Pharmaceutical Sciences. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: c.groenland@erasmusmc.nl

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