Background and Aim
Following an acute stroke (AS), patients are at an increased risk of developing complications
that may affect prognosis. With overcrowding in the emergency department (ED), patients
stay longer hours to days before transfer to a proper stroke ward. The aim of this
study was to evaluate the effect of increasing length of stay (LOS) in the ED on the
risk of stroke-related complications.
Methods
We analyzed data from our stroke registry of patients admitted with AS during 2014.
Stay in ED was divided into 2 groups: less than 8 hours and more than 8 hours. Data
regarding demographics, stroke type, severity of stroke, ED (LOS) in hours, total
LOS in hospital, number and types of complications, and prognosis were collected.
Results
Mean age was 54.8 years and 78.9% were males (total n = 894). Prior to ward admission,
265 (29.5%) patients remained in the ED for less than 8 hours and 629 (70.4%) remained
for more than 8 hours. There was no significant difference in comorbidities or the
severity of stroke at admission between the 2 groups. An ED LOS of less than 8 hours
was associated with reduced risk of complications (14.3% versus 19.2%, P = .06), reduced LOS in hospital, better prognosis at discharge (72.5% versus 57.6%
had modified Rankin Scale of ≤2, P = .001) and at 90 days (89% versus 78.8%, P = .007) and lower in-hospital mortality (1.5% versus 5.4 %, P = .004).
Conclusion
Delays in transferring AS patients from the ED may lead to an increase in complications
resulting in an increased LOS and slower recovery.
Key Words
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Article info
Publication history
Published online: December 31, 2015
Accepted:
October 22,
2015
Received:
September 8,
2015
Footnotes
All investigators volunteered their time to conduct the study and to prepare the final study report.
Dr. Ashfaq Shuaib had access to all the data and had the final responsibility for the decision to submit the article for publication.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.10.018
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
