impact of [admit no bed] and long boarding times in the emergency department on stroke outcome

ABSTRACT

To examine and test the possible association between boarding time and stroke patients' outcome. This study is a retrospective review of stroke patients presenting to the Emergency Department [ED] of King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia from 2007-2010. We excluded thrombolysis cases and those deemed critically ill. We collected time of stroke onset, ED arrival, decision to admit, and arrival to ward. Boarding time [BT] was defined as time of arrival to ward minus time of decision to admit. Primary outcome [PO] was defined as a composite of mortality, and/or any of post-stroke complications. We included 300 patients with a mean age +/- standard deviation of 69 +/- 12 years, and 66.3% were men. The PO occurred in 37.7%. There was no association between BT and PO [odds ratio [OR] =0.9, p=0.3[, or any of the secondary outcomes, such as, death [OR=0.97, p=0.5], severe disability [OR=0.97, p=0.3], pneumonia [OR=1, p=0.9], urinary tract infection [OR=1,p=0.9], or neurological deterioration [OR=0.8,p=0.1]. Multivariate analysis included gender, age, stroke severity, subtype, hypertension, diabetes, coronary disease, atrial fibrillation, heart failure [HF], onset to ED, BT and ED wait time; only moderate to severe stroke, HF, and previous stroke predicted poor outcome. Although [admit no bed] was not associated with adverse effects, the results should be interpreted with caution, and early admission to the stroke unit should be encouraged