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PURPOSE@#To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients.@*METHODS@#Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma team activation were included in the study. EDLOS was determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h.@*RESULTS@#A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78-180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups.@*CONCLUSION@#EDLOS is not a significant parameter for HLOS in stable trauma patients.
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Emergency Service, Hospital , Hospitals , Intensive Care Units , Israel , Length of Stay , Patient Admission , Patient Outcome Assessment , Time Factors , Trauma Severity Indices , Wounds and InjuriesABSTRACT
Objective·To investigate the effect of population aging on health condition of Emergency Department (ED) visitors, the disease constitution of ED, the pressure of emergency treatment and the emergency department length of stay (EDLOS). Methods·Patient data from ED of a tertiary hospital in Shanghai from Jan. 2014 to Dec. 2016 were collected and retrospectively analyzed, including gender, age, arrival time, diagnosis, EDLOS, outcome, chronic disease, infection or tumor, etc. Statistics was used to determine possible factors associated with prolonged EDLOS. Results·A total of 15429 cases were selected. The number of the elderly patients (≥65 years old) was 8480 (54.96%). The elderly patients' EDLOS was significantly longer than patients younger than 65 years (P=0.000). The incidence of chronic aging diseases was significantly higher in elderly patients (67%) than in who were below 65 years old (52%). Tumor and infection were independent risk factors for EDLOS (P=0.000). The proportion of elderly patients with acute onset and unknown diseases was only 14%. Conclusion·The increasing proportion of elderly patients in ED is the main reason leading to the pressure of emergency treatment. The elderly patients who had chronic diseases prolong the EDLOS and cost the most medical resources of emergency treatment. So the gerontology should be rapidly expanding. Meanwhile, the complex chronic aging diseases, acute onset of chronic disease and varying severity of disease in the elderly patients should be treated by the new stepping mode "Family- Hospitalization-Emergency".
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Objective·To investigate the effect of population aging on health condition of Emergency Department (ED) visitors, the disease constitution of ED, the pressure of emergency treatment and the emergency department length of stay (EDLOS). Methods·Patient data from ED of a tertiary hospital in Shanghai from Jan. 2014 to Dec. 2016 were collected and retrospectively analyzed, including gender, age, arrival time, diagnosis, EDLOS, outcome, chronic disease, infection or tumor, etc. Statistics was used to determine possible factors associated with prolonged EDLOS. Results·A total of 15429 cases were selected. The number of the elderly patients (≥65 years old) was 8480 (54.96%). The elderly patients' EDLOS was significantly longer than patients younger than 65 years (P=0.000). The incidence of chronic aging diseases was significantly higher in elderly patients (67%) than in who were below 65 years old (52%). Tumor and infection were independent risk factors for EDLOS (P=0.000). The proportion of elderly patients with acute onset and unknown diseases was only 14%. Conclusion·The increasing proportion of elderly patients in ED is the main reason leading to the pressure of emergency treatment. The elderly patients who had chronic diseases prolong the EDLOS and cost the most medical resources of emergency treatment. So the gerontology should be rapidly expanding. Meanwhile, the complex chronic aging diseases, acute onset of chronic disease and varying severity of disease in the elderly patients should be treated by the new stepping mode "Family- Hospitalization-Emergency".
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Objective To evaluate the relationship between emergency department length of stay (EDLOS) and outcome of multiple trauma patients in ICU.Methods A retrospective cohort study was performed in multiple trauma patients admitted from the emergency department to ICU during 2010.Patients' data were recorded,including demographic information (gender,age,etc.),characteristics of injury (injury causes,diagnosis,ISS,GCS,emergency operation rate,type of operation),and outcome (inhospital mortality,length of ICU stay,total length of hospital stay,expenditure).Patients were assorted into delayed group (EDLOS ＞ 6 h) and non-delayed group (EDLOS ≤ 6 h),then demographic information,characteristics of injury,and outcome were compared between the two groups.Multivariate Logistic and linear regression analyses were performed to identify the correlation between EDLOS and outcome for all patients and for those with and without emergency operation.Results A total of 476 patients aged (47.5 ± 16.0) years were enrolled in the study and male patients accounted for 73.5％.Median ISS was 29 points (interquartile range,22-34 points),median EDLOS was 4.0 hours (interquartile range,2.8-6.4 hours),and inhospital mortality was 9.2％.Delayed (n =135) and non-delayed (n =341) groups were similar in age,gender,ISS,inhospital mortality (13.3％ vs 7.6％),length of ICU stay,and total length of hospital stay (P ＞ 0.05).Multivariate analysis demonstrated prolonged EDLOS increased inhospital mortality (OR=3.19,95％ CI 1.28-7.95,P ＜ 0.05),especially in patients without emergent operation (OR =4.01,95％ CI 1.31-12.27,P ＜ 0.05).However,prolonged EDLOS produced no effect on mortality in patients with emergent operation (OR =1.72,95％ CI 0.79-3.43,P ＞0.05),length of ICU stay,total length of hospital stay,and expenditure.Conclusion Prolonged EDLOS increases mortality of multiple trauma patients admitted to ICU,especially in patients without emergency operation,thus rapid transportation of these patients from emergency room to ICU will improve the outcome.
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PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. METHODS: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. RESULTS: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. CONCLUSION: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.