Prolonged Length of Stay in the Emergency Department and Mortality in Critically Ill Elderly Patients with Infections: A Retrospective Multicenter Study.

Woon Jeong Lee,Chun Song Youn,Sanghyun Park,Bartlomiej Perek,June Young Lee,Kyungman Cha,Sikyoung Jeong,Wonjin Choi,Dae Hee Kim,Seon Hee Woo

doi:10.1155/2021/9952324

Abstract

Background This study aimed at investigating whether the length of stay (LOS) in the emergency department (ED) is associated with mortality in elderly patients with infections admitted to the intensive care unit (ICU). Delayed admission to the ICU may be associated with adverse clinical outcomes in elderly patients with infections. Methods This was a retrospective study conducted with subjects over 65 years of age admitted to the ICU from 5 EDs. We recorded demographic data, clinical findings, initial laboratory results, and ED LOS. Outcomes were all-cause in-hospital mortality and hospital LOS. A multivariable regression model was applied to identify factors predictive of mortality. Results A total of 439 patients admitted to the ICU via the ED were included in this study, 132 (30.1%) of whom died in the hospital. The median (IQR) age was 78 (73, 83) years. In multivariable analysis, a history of malignancy (OR: 3.76; 95% CI: 1.88–7.52; p < 0.001), high lactate level (OR: 1.13; 95% CI: 1.01–1.27; p=0.039), and ED LOS (OR: 1.01; 95% CI: 1.00–1.02; p=0.039) were independent risk factors for all-cause in-hospital admission. Elderly patients with an ED LOS >12 hours had a longer hospital LOS (p=0.018), and those with an ED LOS > 24 hours had a longer hospital LOS and higher mortality rate (p=0.044, p=0.008). Conclusions This study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. ED LOS should be considered in strategies to prevent adverse outcomes in elderly patients with infections who visit the ED.

Highlights

Wonjin Choi,1 Seon Hee Woo,1 Dae Hee Kim,1 June Young Lee,1 Woon Jeong Lee,1 Sikyoung Jeong,2 Kyungman Cha,3 Chun Song Youn,4 and Sanghyun Park5
Of the 459 older adults admitted to the intensive care unit (ICU) via the emergency department (ED) with a suspected infection during the study period, 9 who died within 24 hours of visiting the ED, 4 who experienced the return of spontaneous circulation after out-of-hospital cardiac arrest, and 7 receiving palliative care or who had missing data in the ED were excluded. us, 439 patients were included in the study. e most common infection was pneumonia (271 patients; 61.7%) (Table 1)
None of the comorbidity rates except that of malignancy was significantly different between the two groups (29.5% vs. 10.7%, p < 0.001). e median systolic BP was lower in nonsurvivors (p 0.036). e platelet counts and total bilirubin, albumin, and lactate levels were significantly different between the two groups

Summary

Introduction

Is study shows that prolonged ED LOS is independently associated with all-cause in-hospital mortality in elderly patients with infections requiring ICU admission. Other studies have shown that a longer delay in ICU admission in patients with severe disease is associated with more adverse effects on mortality and treatment outcomes [10,11,12]. These studies did not take into account patient age; instead, they evaluated the overall population visiting the ED who were diagnosed with a critical illness and admitted to the ICU. Few studies have investigated the effects of ED length of stay (LOS) on elderly patients

Methods

Results

Conclusion